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TREATISE
ON
CLINICAL MEDICINE,
BEING A
COMPENDIOUS AND SYSTEMATIC
INTRODUCTION TO PRACTICE,
AS CONTAINED IN THE MEMORANDA OF
I. R. BISCHOFF, M.D.
IMPERIAL PROFESSOR OF CLINICAL MEDICINE, PHYSICIAN
TO THE GENERAL HOSPITAL, AND ALSO TO THE
LVING-IN HOSPITAL IN PRAGUE.
FROM THE GERMAN,
BY JOSEPH COPE, M.D.
LONDON :
PRINTED BY C. SMITH, ONE BELL YARD, STRAND.
SOLD BV JOHN ANDERSON, WEST SMITIIFIELD ;
MESSRS. T. AND G. UNDERWOOD ; S. HIGHLEY ; CALLOW AND
WILSON ; COX AND SON ; AND OTHER MEDICAL BOOKSELLERS.
1827.
“ Veruiu quod ad Praxin attiuet, profiteer me omnia ex ven.'
tradidisse, niiiilque uspiam proposuisse nisi quod probe explo-
ratiim habeam, &c.”— Sydenham.
“ Votorum ideirco me compotem fortunatumque reputabo si
opellfl. hac mea, utut tenui iic levidensi, ad profiigauda peruicio-
sarum opinioiium commenta conferre boni quid, distinciioresque
morborura quorundam vulgatiorum notiones communicare, atqne,
ab Omni vanfi hypothesi alieniis, observata aliorum nondum for-
tasse suflicientur comprobata, fidarum obserrationum suffrasrio
valeam confirmare.” — Stoll.
NOTICE BY THE EDITOR.
-00-
The Author of the following Work has,
with the utmost veracity and candour, de-
scribed the history and treatment of one
hundred and forty-eight cases, and added
a variety of excellent practical remarks.
As we seem to want a systematic treatise
on clinical medicine, I have been induced
to make this available to the British stu-
dent, who may hence derive great advan-
tage both in his studies and future practice.
The pathology and treatment adopted
by the Author are those of the Vienna
school, perhaps the best in southern Eu-
rope ; they differ somewhat from our own ;
but it may be questioned whether they
are not better adapted to the diseases of
that latitude, and on this account the more
essential to be known by a very great part
of the profession, whom the public service
or their own interests may cause to prac-
tise in hot climates.
I have not found much that required
explanation ; when this has occurred 1
a 3
c Vi ;]
have added a note, adapting throughout,
as far as I was able, the nomenclature of
our Pharmacopoeia, and using that of
Austria for my guide. The notes at pages
29 and 256 will require the cursory Rea-
er’s attention.
I could have wished to have rendered
the expression in the note at page 25 more
intelligible ; this however is not of much
consequence, as the context sufficiently
shews the Author’s meaning. At page 37,
line 27, R. Gram, should have been ex-
plained by a note to be the root of the tri-
ticum repens.
I have added to the Table of Contents a
reference to some remedies which appear-
ed to me interesting, from their not being
used in this country at all, or not generally
known to possess the virtues assigned them
by the Author.
I have chosen this diminutive form for
the convenience of the students in medi-
cine, my sole aim having been to draw their
attention to, and facilitate this most essen-
tial, and, as appears to me, most neglected
part of their studies.
London, May, 1827.
J. C.
PREFACE.
I HAvn endeavoured in the following sheets,
by a description of the mode of treatment adopt-
ed in the medical school for surgeons, to satisfy, as
far as I was able, an often expressed wish, that
clinical teachers would give to the public a parti-
cular account of their effective practice* This
work is the result of observations and discoveries
made in this school during the years 1823, and
1824; it details facts with truth and simplicity;
as nature presented them in her morbid appear-
ances to unprejudiced observation, and without
reference to any theoretical system.
Medicine is, without doubt, one of the most be-
neficial but yet most difficult sciences ; it compre-
hends the whole extent of natural knowledge ; its
high object is to preserve or restore health, the
most inestimable of earthly possessions ; the value
of which Neubeck thus admirably expresses: “to
be without it, is ceasing to live, and yet not dy-
ing.” The ])hysician’s office is certainly one of
the most difficult in civil life, and the object of his
c viii ;]
art one of the most important in human existence —
it is life itself ; he must be, therefore, thoroughly
acquainted with the laws which regulate disease ;
these, however, are not expounded in any bene-
ficent code, and he must learn to interpret (as its
hints and language) the numberless forms and va-
riations which man’s nature presents in its suffer-
ings ; and thence by the aid of the experience of
others and his own, deduce general rules of the-
ory and practice. It is self-evident how trouble-
some and difficult this method must be ; and
hence such a variety of systems, which have been
so much the less propitious to mankind, as they
have advanced phantoms of the imagination for
principles, or deviated from experience, the only
true fountain of medical knowledge. This is, and
must ever be the pedestal of medical science, it is
obtained by the free and unbiassed observation of
nature ; and it is by so much the better grounded
and sure, as it is taken from numerous and well
connected cases. For this reason I have not chosen
for demonstration cases which were remarkable
only for the danger attending them, or their rarity,
but frequently simple and mild ones, for these, in-
deed, are what most usually occur in practice, and
require the greatest attention; by the proper treat-
ment of these they are prevented from rising to
greater acuteness, and endangering the life of the
patient ; and the physician who thus conducts a
mild disease with safety to recovery, and prevents
it from assuming a more serious form, is certainly
c: ix ;]
as useful as he who happily rescues a patient from
a state of already imminent danger. Besides, even
the most common diseases are not always uniform;
they are often attended at the outset with consi-
derable danger, undergo each year very great
changes, and such as influence their treatment,
and in many cases great practical acumen is re-
quired rightly to seize and know what in so many
diseases is often insidiously concealed under the
mask of mildness. It is from ignorance of this,
and the consequent neglect, that that degree of
danger but too frequently comes on, in which pa-
tients are so often brought to hospitals as to their
last resource.
PubUc establishments for the sick, where the
suffering and truly helpless are received with hu-
manity and kindness, and in which every thing is
prepared in a comprehensive manner for their re-
lief, are certainly in this respect among the most
beneficent regulations. The hearty thanks of
thousands, thereby saved, bless the founders of
these establishments, as also the benevolence and
kindness of His Majesty, our most gracious
Emperor, who has been pleased not only con-
stantly to honour them with his peculiar support,
but also, where there was a deficiency of room for
the numerous applicants, to order, at great ex-
pense, additions to be made to them.
Public hospitals are also at the same time the
c X :]
most instructive schools for experience, the true
source of instruction, the best means of extending
useful knowledge, and advancing medical science ;
and though it cannot be denied that many noble
results of a happy termination in the most threat-
ening diseases are dismissed from them ; yet, on
the other hand it is to be lamented that but too
often such patients either through neglect, im-
proper treatment, or the ignorant use of domestic
remedies, (often violent) have been thus artificially
brought into danger, and not till then become the
objects of our art. To the physician who knows
how to distinguish and properly treat the most
common diseases, the aid of his art will seldom be
found wanting in the more unusual cases, as he
knows at once, from much practice, when he meets
with them ; whilst he who attends only to extra-
ordinary diseases, will, in common ones, be liable
to err in his diagnosis, and think, often without
reason, that he has performed miraculous cures.
The words of the great Stoll may be here applied.
“ I have, says he, also in this year not earnestly-
sought after what was uncommon, in my observa-
tions, but rather aimed to sketch, as in a faithful
picture, the constitution of the year, the changes
of the vveather, and the causes and progress of the
diseases which occurred ; and to shew with pre-
cision the various connexions and transitions of
those maladies which followed each other ; the
manifold forms which they assumed in one and
C xi 3
the same season, though (like the heads of the
Lernaean snake) they sprang from the same source.
I hold those entitled to great praise who ardently
devote themselves to new discoveries ; yet I esteem
the labour of those not less useful, who examine,
limit, extend, or correct the opinions of our prede-
cessors ; the former discover unknown countries —
these teach how to cultivate with advantage their
native soil ; their work is rewarded with less fame,
but is productive of so much greater profit.”
Thus spoke, forty-five years ago, the immortal
teacher ; words deserving to be deeply impressed
on the mind of the true physician of every age,
and set before him as the rule of his conduct.
* In the establishment of schools on the practice
of physic for surgeons, the supreme Government
of Austria had chiefly in view the instruction of
a sufficient number of medical persons ; so that, in
all those places of the Empire where there was a
want of physicians, every subject might neverthe-
less receive the necessary help when attacked by
disease.
In the preface to my book, entitled “Elements of
Practical Medicine, exemplified by Cases,” I have
endeavoured more minutely to explain this subject.
If we consider the conditions of human society,
we find in fact, that in every country the phy-
* Preface to the Annuary of 1824.
C xii '2
sicians could not possibly attend more than a sixth
part of the sick. A five times greater number, viz.,
the very numerous class of country people, is in
consequence consigned to the surgeon’s care.
The influence of this branch of a profession so
essential to the public good is therefore very great,
and the surgeon is by the existing laws obliged,
both in the country and in small towns, where there
is no physician, to supply his place in a reputable
manner. The life therefore of his fellow citizen
being confided to the surgeon, a perfect acquain-
tance with the nature and course of diseases, also
integrity and discretion, are, with great reason, re-
quired of him as primary qualifications. To enable
them to fulfil this important charge, surgeons re-
ceive (as in eleven cases wliich occur, ten are
medical ones) practical instruction in the science
of internal medicine; this should be simple,
adapted to their capacities and more confined
education, attainable by the generality, and yet
grounded; that in sudden and dangerous cases,
where immediate help is required, they may' know
how to act according to well directed and right
principles; and that human life may not be
entrusted to inexpenenced hands; they are at
the same time bound by the highest authoritv, in
consideration of their more limited attainments, to
call in the advice of a physician as soon as possible
in cases of consequence and danger, and to con-
tinue the treatment thereof under his guidance ;
C xiii ;]
the physician is also to assist in all surgical opera-
tions.
This institution has now been formed in the
University of Prague twelve years ; and about
500 surgeons, already spread over the kingdom of
Bohemia, received therein their instruction.
In the following treatise I have sought partly to
present to my hearers a memorandum of the
clinical cases of the present year, and also to render
to the profession at large, in a short view, a public
account of the method of treatment used, accord-
ing to the present state of medical science in this
school.
Medicine must ever be the daughter of experi-
ence. All experience arises from facts, to collect
which with the greatest care, and from their tenor
to deduce results profitable to humanity ; to teach
the student how to observe nature in her morbid
manifestations, clearly, and without prejudice, and
from such observation to ground the method of
cure, is the great duty of the clinical professor.
But in order to accomplish in the most certain^
manner the great object of introducing the student,
who has already gained the necessary theoretical
information, into the career of practice, and to
form him (according to that sphere of it which falls
to the surgeon’s lot) for a conscientious, useful,
and prudent discharge of his duty, the following
plan is adopted in the clinical school : — Every
patient when admitted is made over to a student,
b
c: xiv ;]
as his ordinary, who then publicly, and in the
presence of the professor, makes, with all possible
exactness, that so essential examination of the
patient, by which the following are made out in
the most careful manner 1st. The patient’s habit
of body, and an account of his previous maladies.
2d. The exciting causes. 3d. The commencement
and course of the disease to that period. 4th.
The symptoms of the disease at the time of ad-
mission. 5th. The remedies already applied, and
their effects. After this merely collective and
simply historical procedure, we pass to the second
and most important point, the determination of
the disease or diagnosis. And this is deduced from
the above data acquired in the following order ;
viz., the habit of the patient, the exciting causes,
the course and symptoms of the disease, and which
are hence called the diagnostic momenta. What
the disease has in common with others allied to it,
and how to be distinguished from those which re-
semble it, is then brought forward ; the case under
examination is compared with the reigning con-
stitution, whether stationary, epidemic or en-
demic, and the connexion of the present symp-
toms with the preceding causes is investigated ;
from these the conclusion is drawn, as from cause
to its effects, so as to determine the disease as to
its nature, character, form, stage, and degree of
acuteness, and by giving it a name to assign the
place it holds in nosological systems. By the
C XV ]
diagnosis we are led, with the aid of singly col-
lected facts, to a general idea of the disease ;
and here the practical teacher follows a method
the reverse of the pathologist, who first establishes
the idea of the disease, and afterwards assigns
its symptoms, causes, divisions, &c. By means
of the diagnosis, the physician sees at once
the previous, present, and future course (progno-
sis) of the disease. This last he endeavours to
establish according to the probability, whether the
disease will terminate in health, in another disease,
or in death. The prognosis, when given in the
vernacular tongue, requires very great caution,
lest the patient’s courage should be cast down by
the detail of unfavourable symptoms; whence in
many cases it must be omitted in the patient’s
presence, and reserved for another place.
After the diagnosis is established, the third
principal proposition follows, viz., the plan of
treatment. "1 his is grounded on the accuracy of
the diagnosis, and on the indication thereon con-
structed, that is, on the determination of the
changes which must take place in the patient’s
frame, from nature or art, to bring about the cura-
tive process ; and as these changes are either ef-
fected by nature or by art, so there is a natural
and an artificial cure.
Our first object is to procure the removal, as
far as possible, of the efficient causes; but this may
be no longer in our power: diseases then require.
c: xvi ;]
with respect to their treatment, a two-fold and
very material distinction ; some can only be favour-
ably terminated by the powers of nature, and the
body is thus restored to health. In others, nature
yields in the conflict, or would by herself only
produce an unfavourable issue. In the former,
the object of treatment consists in not interrupt-
ing her course, but in keeping it as regular as
possible ; a quiet observant practice must here be
employed, which uses mild remedies adapted to
the case, removes impediments, and exactly assigns
the diet and regimen. But when the disease is
not able of itself to finish desirably its course, then
a more or less powerful interference of our art in
the progress of the disease takes place. It would
be unpardonable to act the mere observer where
an urgent indication requires our interference ;
and it is the great problem of practical medicine
to know in what cases nature is to be left to her-
self, and where she is to be assisted by art, and
the manner of doing it.
According to the determined indication, the
appropriate remedies are adjusted as accurately
as may be to the patient’s constitution ; they are
ordered with all possible simplicity, and the diet
is assigned with the greatest care. All that in
this short review has been set down respecting
the patient, is now put down by the ordinary in
writing, and in the same order, with truth and
clearness, and read out publicly on the following
C xvii 3
day, as the history of the disease or pathologic
biogi-aphy. During the course of the disease it
becomes the duty of the ordinary, daily, before
the professor’s visit, to examine the patient, and
to set down in writing the changes that may have
taken place, and the general appearance of the
disease. On the opening of the clinical school,
these observations are read out, their truth con-
firmed, their errors corrected, and the whole
amended.
By this a two -fold object is attained;—!. The
student himself learns to make observations. 2.
A bar is put to the making out the patient’s case,
after perhaps the lapse of some days, and often
from an uncertain memory ; by which occasion is
given to such extraordinary and scarcely credible
accounts of disease. In this manner the treatment
IS continued till its termination in a cure or death.
In the last case the post mortem examination
takes place; previous to which, in reference to the
disease, the morbid appearances most likely to
present themselves are stated. During the exa-
mination, these are noticed with the greatest atten-
tion, and consigned to writing. The whole is
now compared with the history of the disease and
the previous diagnosis ; the account of the exa-
mination IS again publicly read on the following
day ; the true or mistaken judgment exposed, and
t e practical results deducible from it, particu-
larized.
b 3
C xviii '2
This is the mode of clinical instruction, by
which, indeed, the possibility of error, the com-
mon lot of mortals, is not prevented, but that of
untruth is avoided. The cases are not here re-
corded with the minuteness observed in the
school, but a sketch is given in which nothing
essential is omitted. They serve more especially
as a short repetition of what was in a detailed
manner stated with each case, and as a help to
the memory. My endeavour was throughout to
exhibit with truth and simplicity, and entirely from
observation and experience, the course of diseases
as presented by nature, and the mode of treat-
ment employed therein.
It is one great perfection of the art, when in
spite of the deceitful appearance of various and
often violent forms of disease, it teaches quietly
to observe their course, not meddling but when re-
quired, and then with few and effective remedies,
supported with a legitimate indication.
The objection to my using so often the same
remedies I consider ill-founded, provided a perfect
cure, the chief object, is attained; and our art is
Surely so much the more estimable when it attains
hs ends by few and simple remedies, especially in
cases of difficulty and danger. The cases chosen for
the clinical school were taken from the wards of
the Imperial General Hospital, into which (without
including the house for insane persons, and that
for lying-in women) upon an average there are
C xix '2
admitted 1800 yearly, and in sickly seasons 2500.
But in order that the other important and remark-
able cases may serve to promote the good of the
Institution, and the acquirement of knowledge, it
is so arranged that at certain times, as also when
interesting cases occur, the students are conducted
into the remaining wards, where the professor
treats on any subject with the case best suiting it
before him.
From the number of patients, compared with
that of the students, it follows that each would be
obliged to undertake the care of two at least; some
had the opportunity of treating three or four.
ith respect to the nomenclature of the dis-
eases, I have principally adopted the Latin names,
for this reason, that according to the rules of the
Institution, the name of the disease in the Latin
idiom is always stated, both on a tablet which
hangs by the side of each patient (and on which
are also particularized his name, age, date of ad-
mission, duration of the disease, remedies and diet),
as also in the registers of the hospital. Moreover,
these names are commendable from their anti-
quity, known in all languages, and as necessary to
be known to medical persons, as the Latin names
of plants are to the botanist.
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CONTENTS
-00-
Iiitroduction, 1, 194.
Diseases in the order of their admission, 2, 195.
Nosological tables of them, 5, 198.
-State of the weather
{
Annual, 7, 200.
Monthly, 9, 201.
&c.
Prevailing character of Disease
f Annual, 13, 200
\ Monthly, 13, 201. &c.
REMARKS ON AND TREATMENT OF CASES.
Abdomen, inflammations of the, 102.
Apoplexy, 218.
and palsy, 271.
Brain, inflammation of the, 73, 202, 258, 260.
Catarrh, 32, 213, 226.
Chronic diseases, 158.
Colic, 188.
menstinial, 189.
haemorrhoidal, 268.
inflammatory with ileus, 269,
Constipation, 171.
Consumption, 181, 186, 227.
Convulsions, 190, 216, 264.
Coxalgia, 206.
Croup, 214, 219.
Cutaneous affections, 179.
Diarrhoea, 170.
Dropsy, 171.
general, 258.
CONTENTS.
Dropsy, general, with peripneumony, 175.
from measles, 176.
gout, 177.
of the bimn, 48.
acute of the chest, 265, 27.9.
Dysenteiy, 116.
Ear, inflammation of the, 261.
Epilepsy, 227, 248.
Erysipelas, 128, 129, 131, 254.
Fever, bilious, 50, 51, 52.
gastric, 43, 44.
and neiTous, 47.
with cough, 45.
sore throat, 46.
saburral, 278.
inflammatory, 28, 29, 30.
intermittent, 154.
quotidian, 155.
— - — tertian, 156, 157, 234, 235.
nervous, 56, 61, 204, 231.
and putrid, 267.
— with irritation of the brain and chest, 212,
with miliary eruptions, 62.
with pleurisy and enteritis, 66, 69.
pituitous, 54.
puerperal, 113, 114, 115, 207.
putrid, 71.
typhus, 140, 146, 148.
witli peripneumony, 149.
— petechiae, 151.
putrid with inflammation of the pharjTiX, 152.
Giddiness, 192.
Gout, 120, 125, 126, 222, 223, 232, 262.
Haemorrhage, 158.
of the lungs, 158, 161.
stomach, 262.
womb, 162, 263.
during pregnancy, 166.
CONTENTS
Hamorrhage, after delivery, 167.
Heart, disease of the, 235.
Intestines, inflammation of the, 241.
Itch, 179.
Jaundice, 180.
from affection of the mind, 181.
Joints, inflammation of the, 119.
Larynx, inflammation of the, 76, 77.
Liver, inflammation of the, 103, 105, 245.
chronic, do. 104.
.Measles, 132, 138.
with diarrhoea, 136.
laryngeal affection, 137.
Nettle rash, 221.
Obstructions, \isceral, 177.
Ovary, inflammation of the, 237.
Paralysis, 224.
Peripneumony, 93, 94, 217, 243.
after measles, 96.
with pleurisy, 234, 248.
and sore throat, 97.
and hydrothorax, 244.
affection of the diaphragm, 95.
inflammation of the pericardium, 100.
followed by nervous fever, 98.
Peritonitis, 109, 110, 237.
rheumatica, 112.
Pleurisy, genuine, 88.
spurious, 85.
rheumatic, 87.
— with abortion, 89.
spasms, 90.
and bronchitis, 92.
with syphilis, 277.
Rheumatism, acute, 35, 37, 39, 215.
of the foot, 247.
passing into an intermittent, 38.
connected with pleurisy, 41.
glandular swelling.s, 210.
CONTENTS.
Rheumatism and sciatica, 127 , 243, 206.
Salivation, 217.
Scarlatina, 138, 238.
maculosa, 139.
Sore throat, 74, 75, 237.
Spleen, inflammation of the, 107, 228, 246.
Syphilis, 249, 252, 253, 254.
Womb, chronic inflammation of the, 238.
REFERENCE TO THE USB OF CERTAIN REMEDIES.
Animonise murias, (passim in febribus adi/mmtcts.J
Amies, Rad. et Flor. 55, 65, 71, 205, 273.
Camphora, 174.
Levistici et Ononodis Rad. 174.
Potass® srdphuret, 92, 97 .
Potassafusa, 65, 273.
SalvisE.xtr. 186.
Saponaris Rad. 180.
Sods mnrias, 161.
Zinci Oxyd. 239.
At page 94, line 11, for =ij. read, 50.
CLINICAL ANNUARY.
FOR IS2S.
-CO-
The opening of the School on the Practice of
Physic for Surgeons, took place in the Season
1822-23, on the 11th of November, and there
were, up to the end of August, 14d cases treated ;
of these, 52 were men and 89 women ; chiefly from
the lower orders of society, and for the most part
labouring under an aggravated state of disease.
Among the cases those were particularly selected
as examples for the treatment, which represented
the reigning epidemic; so that the clinical ward
might be consi('ered as a compendium of the then
prevailing diseases. Also many chronic cases
were admitted, chiefly those which required the
ready help of medicine. Of the patients treated,
127 were cured; 10 died (six men and four
womenj, 2 were left in the same state, one a case
of consumption, the other of chronic metrorrhagia ;
two were at the end of the Season transferred to
the hospital, where they both did well.
c: 2 ;]
The diseases treated were in the order of their
admission, as follows ; —
In the month of NOVEMBER, 1822.
1 Tussis chronica
2 Febris inflaiumatoria rheu-
raatica cum affectione gas-
trica
3 Febris iuflammatoria ce-
jjhalica
4 Pleuritis sinistra
5 Febris inflainmatoria rheu-
matica cum affectione pec-
toris.
6 Pleuritis et pericarditis +
7 Febris inflammatoria cepha-
lica, serius miliaria
8 Psoitis
9 Scarlatina
10 Erysipelas faciei
DECEMBER.
1 1 Hepatitis rheumatica
12 Pleuritis spuria
13 Pneumonia nothaSydeuhami
1 4 Febris puerperalis
15 Febris inflammaloria catar-
rhalis cum affectione pul-
monum
16 Icterus
17 Splenitis
18 Inflammatio glandulae thy-
roideae
19 Erysipelas faciei
20 Febris pituitosa lenta +
21 Peritonitis puerperalis
22 Febris rheumatica catarrha-
lis
23 Bubo syphiliticus -
24 Fehris nervosa lenta
JANUARY, 1823.
25 Hsemorrhagia Pulmonum
26 Febris rheumatica
27 Peritonitis dorsalis
28 Erysipelas faciei
29 Peripneumonia in characte-
rem nervosum desiuens
30 Tussis chronica
31 Morbilli
32 Febris nervosa ex gastrica
orta -f-
33 Splenitis+
34 Febris catarrhalis in nervo-
sam vergens
35 Erysipelas faciei
36 Febris rheumatica
37 Inflammatio testiculi et an-
gina membranacea in in-
fante
38 Pleuritis sinistra
39 Febris iuflammatoria
40 Pleuritis rheumatica
41 Febris intermittens quotidia-
na
42 Febris inflamniatoria rheu-
matica
t Denotes the Case to have been fatal.
• 'I'ransfcrred or left under cure.
The remaining cases were cuied.
c: 3 ]
FEBRUARY.
43 Hepatitis
44 Obstructiones
45 Febris gastrica saburralis
46 Arthritis acuta
47 Pleuritis siuistra
48 Er^’sipelas faciei t
49 Febris pituitosa
50 DiaiThcea
5 1 Pleuritis siuistra
52 Angina tonsillaris
53 Febris pituitosa nervosa
54 Febris intennittens quotidi-
ana
55 Peritonitis anterior
56 Morbilli
57 Febris interniitteus quotidi-
ana in reniittentem vei-sa
58 Febris putrida
59 Pleuritis dextra
60 Pleuritis sinistra
MARCH.
61 Pleuritis rheumatica
62 Scabies
63 Peripueiuuonia
64 Diarrhoea
65 Laryngitis
66 Pleuritis rheumatica
67 Diaphragmitis
68 Angina pharyngea et la-
ryngea t
69 Peripneumonia cum affec-
tionc diaphragmatis
70 Pleuritis et peritonitis
71 Febris idieumatica
72 Arthritis acuta
73 Febris inflam matoria
74 Febris intennittens tertiana
75 Febris inflammatoria
76 Febris intennittens quartana
APRIL.
77 Morbilli
78 Febris rheumatica cum af-
fectione pectoris
79 Febris inflammatoria
80 Pleuritis nervosa et enteritis
occultat
81 Ischias
82 Typhus contagiosust
83 Febris inflammatoria
84 Arthritis acuta
85 Typhus contagiosus
86 Typhus contagiosus
87 Febris inflammatoria
88 Morbilli
89 Febris gastrica
90 Peripneumonia
91 Diarrhoea
92 Hepatitis
93 Obstipatio alvi
94 Pleuritis cum tussi chronica
95 Typhus contagiosus
96 Pleuritis dextra
MAY.
97 Peripneumonia subsequen- 101 Hepatitis chronica
^ tibus morbillis 102 Morbilli
98 'Pussis chronica 103 Urticaria
99 .Morbilli ^ 104 .Angina tonsillaris
100 Metrorrhagia* 105 Colica catamenialis
C 4 ;]
JUNE.
106 Plemoperipneumonicjet an-
gina
107 Febris rheumatica
108 Febris puerperalis
109 Tussis chronica
110 Febris intermittens quoti-
diana
111 Icterus
112 Pleuritis, delude Febris ner-
vosa cum enteritideocculta
11.3 Tussis chronica in phthlsim
abiens *
114 Vertigo nen osa
115 Pleuritis delude febris in-
termittens cephalica
116 Metrorrhagia
117 Febris gastrica biliosa
1 18 Peritonitis anterior
JULY.
119 Pleuroperipneumonia
120 Hepatitis
121 Febris nervosa putrida ex
gastrica orta cumintussus-
ceptione Intejtinorum f
122 Hydrocephalus acutus cum
intussiisceptione Intesti-
norum t
123 Febris iuflainraatoria gas-
trica cum angina tonsillar!
124 Angina tonsillaris
125 Erysipelas faciei
126 Pleuritis sinistra
127 Pleuritis sinistra
128 Dysenteria cum Hepatitide
129 Febris rheumatica
130 Laryngitis et bronchitis
131 Febris inflammatoria cc-
phalica deinde nervosa
cum miliaribus
132 Spasm! et con^ulsiones
133 Peritonitis anterior
134 Febris gastrica biliosa cum
pleuritide
135 Morbilli
136 Febris rheumatica
AUGUST.
137 Hydrops universalis 139 Hydrops universalis
138 Pleuritis etmeuingitis rheu 140 Febris nervosa *
matica 141 Febris rheumatica nervosa*
The diseases arranged in a scientific order,
afford, according to my Tables on acute and cliro-
nic disease, the following view ; —
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c: 7 n
STATE OF THE WEATHER.
The atmosphere, as the supporter and pre-
server of life, (the true pabulum vitae) has the
greatest possible influence on the derangement of
the laws of organization, or diseases. The air is,
through changes of its known physical and chemi-
cal properties, by noxious matters, and even fre-
quently by its own qualities, the great source of
widely spreading diseases; such as depend on the
weather, the seasons, the latitude, and particular
places. From noxious miasmata, unfolded in or
mixed therewith, arise contagious diseases, which
are propagated from one place or country to ano-
ther. The air also becomes by means of peculiar
qualities in its component parts, the cause of the
stationary character of diseases, and of the ap-
pearance of determinate forms of disease in the
different systems and organs; which we indeed
know to be the effects of existing atmospheric
conditions, but we fail in attempting to explain
the manner of their production. So experience
teaches, that in winter the sanguineous system is
most likely to suffer, and thence the inflammatory
character to pi’evail ; that in the hdt seasons the
gastric and biliary systems are most acted upon;
hence bilious fevers, fluxes, choleras, and diar-
rhoeas ; moreover, that in spring and autumn,
phlegmatic diseases and intermittent fevei’s are
most prevalent.
Under what conditions, however, certain dis-
eases appear from changes in the atmosphere,
why, hence, at one time the inflammatory diathesis
should attack the mucous, at another the fibrous
membranes ; why at one time there shall be the
Small-pox, scarlet fever, measles, rashes, and at
C 8 ]
another sore-throats and phthisical coughs ; and
why, often in precisely similar states of the
weather, certain individual organs shall become
the objects of atmospheric influence ; whence, at
one time, inflammations of the organs of degluti-
tion, or of the windpipe ; at another, peripneu-
monies, pleurisies, inflammations of the bowels, or
child-bed fever; and lastly, why certain diseases,
which seldom occur, should, when they do, most
generally prevail, as the mumps, influenza, and
other epidemics both of men and beasts — is as
yet unexplained ; we can only look for their cause
in the unknown changes of the vital energy of the
atmosphere, and their baneful effects on our or-
ganization ; yet the variations in the condition of
the atmosphere, and consequently of the weather,
have the most decided influence, not only on their
productions, but also on the course which dis-
eases take ; as experience teaches that in favour-
able states of the weather, diseases in general pass
through their stages with much greater regula-
rity, so, on the contrary, no practical physician is
a stranger to the fact, that in many constitutions
of the air, all sick persons suffer proportionally
more ; and that, particularly in fevers, (by sudden
changes of the weather) Nature suffers many im-
pediments in her efforts to bring about favourable
crises. Even when symptoms of a favourable crisis
have appeared, their accomplishment has been
prevented, and, by the same means, a material
change is not unfrequently given to the disease
itself.
ft is hence self-evident how essential it is to be
observant of the weather^ — which Hippocrates
most urgently recommends at the beginning of
the book, De Aere, Aquis et Locis.
[19]
In general the winter of this year, which came
in suddenly on the 12th of December, with great
cold, but at lirst without snow, was very severe ;
the earth was every where rent with drought and
cold. It was, moreover, remarkable by a great,
and in many places unheard of deficiency of water,
a consequence of the preceding very dry summer.
The spring was throughout uncommonly warm,
the summer moderately hot, yet with abundance
of rain ; which gave rise in some places to inun-
dations, and a more than usual moisture prevailed,
which was so conducive to vegetation, that this
year deserves to be reckoned among the most
fruitful ones, from the great abundance of all the
necessaries of life. Three fatal epidemics (which
shall be hereafter investigated) give sufficient
ground to account this yeai', in a medical point of
view, as one of the most important ; these were,
1st, the end of the scarlet fever; 2d, the measles;
3d, the contagious typhus.
STATE OF THE WEATHER OF EACH MONTH *.
NOVEMBER 1822.
Harometer. Thermometer.
Highest 29.06 52.7.
Lowest 28.07 8.15.
Mean 28.56 30.42.
InN ovember the weather was alternately cloudy
and serene ; the beginning was quite autumnal,
the days clear and pleasant; on the 11th, cutting
north winds set in, and the thermometer sank sud-
denly below the freezing point. From the 18th
to the end, it was almost daily cloudy night and
• The Author’s notation of the Barometer, and heat has been
changed into that used in England, the Rhenish foot compared
witli ours being taken as lO.'tS to 1000.
m
C 10 3
morning ; from the 14th to the 15th snow fell in
the night ; on the 29th, some gusts of wind were
experienced ; the prevailing winds were west and
south-west.
-
DECEMBER.
Bar.
'flier.
Highest . . .
... 29.01
. . 41.22
Lowest. . . .
. . . 27.97
. . 00.5.
Mean
. . . 28.49
. . 20.63.
December was in the beginning particularlj'
mild and pleasant, but on the 9th it became re-
markably cold. On the 16th and 17th snow fell,
succeeded by a hard frost and increasing cold,
which on the 31st reached the lowest point, \nz.
Zero. The winds were north-east and south-east.
JANUARY 1823.
Bar.
Ther.
Highest . .
. . . . 28.96
. . 40.32.
Lowest . . .
.... 27.8
. 18.17
Mean. . . .
28.38
. . 1 1 .07
This month had at the beginning mostly clear
cold days, snow fell on the 1 2th, the sky con-
tinued overcast. On the 21st the cold increased
and the barometer fell. At eight hours and thirty
minutes, a. m. of the 23d of January, it reached
its lowest point, viz. — 18®. North-west and north-
east were the prevailing winds.
FEBRUARY.
liar. 'J'lier.
Highest 28.62. ........ 46.62
Lowest 27.24 24.8
Mean 27.93 35.7 1
In February it continued very cold, though
c 11 ;]
there were rainy days, and frequent sleet fell.
The south-west and north-west winds prevailed.
MARCH.
Bar.
Ther.
Highest . . . .
. . 28.5
. .. 60.12
Lowest
. . 27.83
. . . 30.42.
Mean
.. 28.16.
jNIarch was remarkable for frequent storms.
Snow also fell during the first foi’tnight ; during
the latter half it rained much, yet the rain was
often mixed with snow. During the last days the
sky was for the most part clear with a south-east
wind. The prevailing winds were north-west and
south-west.
APRIL.
Bar.
Ther.
Highest . . . .
. . 28.79
. . . 69.35.
Lowest
. . . 30.87.
Mean
, . . 28.53
... 50.11.
At the beginning of April there was rain, and
sleet. In the latter half of the month there was
much rain, with occasional storms ; and few clear
days. The north and south-west winds prevailed.
MAY.
Bar.
Ther.
Highest . . . .
. . 28.79
. . . 84.87
Lowest
. . 28.26
. . . 44.37.
Mean
. . 28.53
64.62.
This month was rather clear than clouded.
Between the 8th and 14th there were frequent
storms with rain, only two thunder storms were
observed.
i: 12 n
The winds were very changeable, and ihe tem-
perature very conducive to vegetation.
JUNE.
Bar.
'rher.
Highest . . . i
. . 28.66
. . . 83.75
Lowest. . . . i
. ; 28.07
Mean
.. 28.36
. . . 66.87
June was for the most part rainy ; the atmos-
phere almost throughout clouded ; only one en-
tirely clear day. From the 15th to the 22d tremen-
dous rains fell, and the rivers overflowed. 'The
prevailing winds were south-west and north-west.
JULY.
Bar.
Ther.
Highest
. 28.68
90.5.
Lowest
. 28.17
23.62.
Mean
. 28.43
73.06.
J uly was moderately clear ; though
in the latter
half there was more rain and thunder
. The heat
was on some days
very great.
The prevailing
winds were south-west and
west.
AUGUST.
Bar.
Ther.
Highest
. 28.7
51.07.
Lowest
. 28.36
28.35.
Mean
. 28.53
55.71.
This month was clear, warm, and often sultry ;
particularly towards the end. Some rain and
storms made the heat more tolerable. During
^^he latter half the sky was generally clear.
Prevalent winds south-west and south-east.
n 13 3
PREVAILING CHARACTER OF THE DISEASES.
The inflammatory was the stationary character
of the diseases of this year, and chiefly connected
with rheumatic affections. The former in many
cases was carried to a high degree, to which the
severity of the very cold winter greatly contri-
buted ; yet even in the warm months it was the
most prevalent, and betrayed the most decided
influence on other diseases ; hence the antiphlo-
gistic treatment was in general of most extensive
and beneficial use ; it likewise entirely suited with
the so generally connected rheumatic affections.
The great variety of the seasons, the manifold
changes of the weather caused the annual charac-
ter of the diseases, as well as their treatment, to
undergo in the different months, material changes.
PREVALENT DISEASES IN THE INDIVIDUAL MONTHS.
In the months of November and December, in
which a rather unfixed, cold, and damp state of
the weather prevailed, the inflammatory character
affected more particularly the mucous membranes,
whence frequent catarrhal affections, and particu-
larly in November, there occurred frequent colds,
coughs and diarrhoeas ; which were easily cured
by a moderate antiphlogistic treatment; by the
use of soothing mucilaginous means, and by an
appropriate diet. In November, the last case of
scarlet fever happened. This epidemic, remark-
able for its violence, began in December 1821,
extended itself from January to March, 1822; in
May it began to spread still wider, and to become
general and contagious, and so continued up to
the beginning of November; it attacked children
and adults ; and was, in consequence of the
c
c: 3
unusual violence of the heat in the summer
months, particularly malignant, and dreaded by
its frequently fatal termination ; it was extin-
guished by the great cold of the winter. Taking
a general view of the whole course of this epide-
mic, we shall find that it began as a genuine in-
flammatory affection ; that it passed gradually
during the great summer heat to a gastric bilious
character ; later it inclined more to the nervous
type, and terminated as an inflammatory affection,
but of a milder kind. The prevailing character of
disease was purely inflammatory during the month
of December ; the severe cold which had already
set in, the constant north winds, and the conse-
quent dry frost, favoured more particularly that
diathesis. Many local inflammations of the chest
and also of the abdomen made their appearance,
and required the most energetic antiphlogistic
treatment, with general and topical bleeding. In
January the inflammatory character continued ;
peripneumonies, pleurisies, inflammations of the
peritoneum, and bloody flux were the prevalent
diseases. If in the last months the traces of the
scarlet epidemic disappeared, now those of the
measles were discovered ; not so dangerous as the
former, yet exceeding it in the number of those af-
fected, since, in May,more than 3200 children were
attacked by them. This epidemic was throughout
of the inflammatory catarrhal character, frequent-
ly connected with peripneumony, sometimes with
phrenitis, and uncommonly so with sore throat.
This last affection often appeared at the begin-
ning, in still more cases, and often unexpectedly
in the state of scaling, which was favoured more
particularly by the atmospheric changes of the
cold months of iNIarch and April.
C 15 3
Several important cases of this disease in adults
were treated in the clinical wards ; though it for
the most part affects young persons, and particu-
larly children, which are seldom brought to hos-
pitals. In February, when cold weather prevailed,
the acute rheumatism was most predominant, but
in the following month, March, a distinct tendency
to the nervous character was observable ; perhaps
the unsettled moist state of the weather was con-
ducive to that event. The measles became gene-
ral in the town, and were attended with very
acute symptoms ; they were not in general to be
called malignant, though among the great number
of sick, many dangerous cases occurred, of which
not a few in the city proved fatal.
April was remarkable for the sudden appear-
ance of the contagious typhus, (typhus carceralis)
in the general hospital. It took its rise in the
prisons of the new town, whence the cases were
brought into the general hospital. The cause of
this was, that though the rooms were spacious,
yet a disproportionately great number of culprits
had been brought together, by which the quality
of the air was corrupted,and the typhoid contagion
let loose. It is most worthy of remark in a prac-
tical point of view, that on the 2nd of April the
crowding of the prison took place, and that al-
ready on the 4th, the sick were brought to us,
attacked with fever, stupor, a peculiar dull coun-
tenance, blood-shot conjunctiva, and catarrhal
symptoms. I had not as yet paid attention to the
diagnosis of this important disease, yet the com-
mon origin of it, the arrival of many at the same
time, attacked with fever in the same manner,
and having observed, also, that the peculiar ty-
phous exanthema, (exanthema morbilliforme ty-
i: 16 ]
phosum, purpura typhosa,) as a distinguishing
and characteristic mark, was to be seen in all of
them, (which indeed had at first a great resem-
blance to measles, and might be compared with
the then existing epidemic,) determined me with-
out delay to state the circumstances, in order to
adopt the most effectual means of preventing its
spread ; these were employed with vigour, and
happily put a stop to its further progress. The
characteristic was decidedly inflammatory, yet with
considerable modifications. Its extension was
immediately prevented by a separation of the sick,
and by the employment of fumigations with mine-
ral acids; the last cases of the disease were re-
ceived into the hospital in the following month.
May had a moderate temperature; a firequent
change of the weather favoured the appearance
of acute rheumatism-
June was unusually cool, and rainy almost
throughout ; to this are to be attributed the fre-
quent cases of catarrh, or colds with headache,
inflammations of the throat, coughs, with inflam-
mation of the lungs, and their investing membrane,
but particularly very numerous diarrhoeas ; with
which last not only those out of the town were
affected, but also the patients in the hospital.
As an uncommon circumstance, it deserves to be
recorded, that intermittents, which till now were
so uncommon, again frequently occurred, and
there were more of them treated in this than in
the preceding ten years. In the month of July, in
which the heat began to be oppressive on certain
days, affections of the digestive system were most
conspicuous ; gastric fevers, and among these bili-
ous fevers often appeared, M'hich very readily
passed into the putrid and nervous kind, especially
C 17 3
when the case was neglected, or when, what so
frequently occurred, excessive diarrhoea accom-
panied it. Many sick were admitted in the
complete nervous state, which had been pre-
ceded by gastric symptoms. The dysentery, a
disease which, for a long time, was considered
rare, now appeared, and a few sick were brought
in this month attacked with it. The gastric Wli-
ous character became still more developed in the
month of August, and this was favoured by the
continued hot weather which then prevailed.
TREATMENT OF PARTICULAR CASES.
Many cases of the common inflammatory fever,
without local inflammation of an organ, and where
the chief characteristic is a simple excitement of
the sanguineous system, appeared this year ; they
were, however, in general, of the remittent type,
and rather mild ; and hence more deserving to be
called fevers of excitement. They could only
properly assume the title of synocha, when they
were attended with a greater degree of acuteness,
and had a marked continued type ; now this syno-
cha, without any local inflammatory affection, is,
at least in this country, rather an uncommon dis-
ease, nor does it come to a crisis constantly in the
first cycle of seven, but it goes on from 14 to 17
days, when the crisis takes jflace by sweat, urine
with a sediment, or sometimes by a bleeding from
the nose*.
The common inflammatory fever, or synocha,
presents the model, and as it were, the primary
* The Author in this place goes at large into the definition,
and application of the words Synocha and Synochus, but which,
as he himself apologizes for it, I have thought best to omit.
c 3
c 18 :3
or radical fever, of which all others may be con-
sidered (by otherwise very distinct characters,) as
different modifications ; for though Stoll very truly
remarks, “ nullum omnino dari symptoma quod et
omnem febrem comitetur, et solum et semper;”
yet can w^e have no idea of a fever, without excite-
ment of the sanguineous system, or morbid irrita-
bility of the heart and arteries.
This increased action of the circulation attends
fever through its whole course as a constant symp-
tom. The heart is tlie central organ of the blood,
hence its morbidly increased activity, the changes
of the circulation with regard to its movement
and strength, and of the animal heat.
Since the heart is connected by such au ex-
tended sympathy with all the other vdscera, that
immense list of symptoms is accounted for, with
which, according to Boerhaave, fever is for the
most part attended, and yet without which it may
exist ; as also, why every organ (having capillary
vessels) when excited, is capable, by re-action on
the heart, of producing fever. The symptoms
with which the common inflammatory fever makes
its appearance, coincide in many things with those
of all other fevers ; no organ or principal func-
tion of the system is greatly deranged, and yet
they almost all suffer.
SYMPTOMS OF THE SVNOCHA.
After an usually short notice it comes on with a
sensation of uneasiness and lassitude, with con-
siderable but seldom long continued cold, followed
by heat, wdiich spreads over the wdiole body insen-
sibly and uniformly: this continues through its whole
course, is great, yet does not convey to the touch
any unpleasant mordacious sensation ; it is at first
very hot to the feel, but|appears less so afterwards.
[ 19 3
Tlie pulse, which is the most essential and prin-.
cipal diagnostic symptom in synocha, is, during the
cold stage, very frequently compressed, small, and
somewhat hard ; as the hot stage comes on, it
becomes by degrees full, expanded, tense, strong
and hard ; in its rythm, it remains uniform, yet a
yep' great velocity is no very prominent symptom;
it is, in fact, much more frequent than in health,
yet (with some exceptions) it seldom exceeds 112
strokes in a minute. Children are an exception,
in whom, ydien attacked with inflammatory fever,
the pulse is often extremely quick.
Its frequency, fulness, magnitude and hardness,
are increased in every paroxysm, and in the same
ratio do the other symptoms become more violent ;
should the pulse become slower, softer, or smaller,
these would also become milder.
The above condition of the heat, the firm con-
tinued type, the strength and hardness of the
pulse, are the pathognomonic symptoms of syno-
cha. If during the hot stage the pulse is op-
pressed, contracted, small and hard ; or unlike in
the two wrists, it denotes the accompanying local
affection of some important viscus ; or it may be
caused by pain or spasm. An oppressed, con-
tracted, apparently weak pulse, frequently occurs
in fever, without any real debility, but not the
contrary, for in fevers of all kinds, and, of conse-
quence, also, in bilious, malignant, and putrid
ones, there is no remarkably strong or hard pulse
but indicates an inflammatory tendency ; which,
though perhaps only a temporary one, is, in every
stage, of the greatest practical importance. In
chronic affections, as in hydrothorax, and dis-
eases of the heart, a strong or hard pulse frequently
indeed occurs without any concomitant inflamma-
tion.
n 20 3
When In S3niocha there is the double or pul-
sus dicrotus, we may expect for the most part a
favourable haemorrhage from the nose.
Hippocrates, who was not acquainted with this
kind of pulse, calls our attention to this very crisis
from other attending circumstances. He says,(Epid.
lib.l. sect.ii. 18.)“in those who in acute fevers, but
especially in ardent fevers, shed spontaneous tears,
we are to expect a haemorrhage from the nose,
if they are not dangerously affected.” Also (Lib.
Praenotionum. ab Initio.) “ we should enquire of the
patients,(who having fever, perceive a hard painful
swelling under the short ribs,) whether they have
pain in the head, or are dim sighted, in which
case it is probable they will bleed from the nose ;
we are particularly to expect such an haemorrhagy
in young men who have not passed their thirty-
fifth year.” And further, in the same book, “ in
those who in these fevers are thus affected with
pain in the head, with dimness or weakness of
sight, or who see sparks of fire ; who, instead of
the heartburn, perceive in the hypochondria of
either side, a contraction or pain, without inflam-
mation, we are to expect a haemorrhage from
the nose, rather than a vomiting.” Solanus de
Luque, and Jacob Nihell (Novfe observationes
circa crisium prasdictionem ex pulsu. Traject. ad
Rhen. 1753), have endeavoured to establish by
remarkable observations, and rules founded upon
them, the doctrine of prediction of crisis from the
pulse. According to Solanus, the double beating
pulse is a certain sign of a critical haemorrhage from
the nose, viz., according to the intervals, (in which
it appears) it becomes a determined sign of the
time when the haemorrhage will take place.
c; 21 ;]
He says, “ when the redoubled pulse happens at
every thirtieth pulsation, the haemorrhage will
take place within four days ; if at every sixteenth
stroke,within three days ; if at the eighth pulsation,
within two days ; if at every third or fifth stroke,
within twenty-four hours ; the shorter the inter-
val of the redoubled pulsation, the sooner will the
haemorrhage take place.
If in the double stroke the second wave is
stronger than the first, the haemorrhage will be
abundant ; if both strokes are ahke, it will be
moderate, if the second is weaker, it will be sparing.
To establish the truth of these propositions, cases,
and the testimony of eleven Spanish physicians,
are adduced. Nihell observed the redoubled
pulse in 121 men, and in seven only did the nasal
haemorrhage not take place. We may hence con-
clude, that in the southern climate of Spain fevers,
in respect to arterial action, observe an evidently
different course from tlrnt in our own ; for in our
part of the world the redoubled pulse is much less
common ; (for the most part, indeed, a prelude to
nasal haemorrhage) but by no means according to
the above adopted laws ; and the most experienced
practitioners scarcely would, in a long career, have
seen one half of the number stated.
THE REMAINING SYMPTOMS OF SYNOCHA.
The head is, more particularly in the fore part,
but often throughout, affected with a continued
painful oppression ; without absolute vertigo ; it
is, however, accompanied by wandering in irri-
table subjects and children, and these last have
often a restless tossing about, starting, and con-
vulsions. The sleep is not calm, but interrupted
with frightful dreams, during which children often
start from their beds.
t: 22 3
The countenance is flushed, red and hot. The
eyes are protruded and sparkling, the look is
animated, fiery ; the eyelids are often contracted
and painfiil. The nostrils, lips and mouth are d^’,
the smell is deficient. The tongue is moist, quite
red, or entirely covered with a thin white coat;
sometimes it is half dry. The thirst is continued,
and ardent, with desire of cooling acid drinks,
yet it may be satisfied ; sometimes it is moderate,
or not at all increased. The appetite is entirely
wanting, as is the taste ; or it is faint and some-
times metallic ; the mouth generally dry. Res-
piration is performed chiefly by the thoracic mus-
cles ; it is strong and sometimes deep, yet a deep
inspiration gives no pain ; the breath is hot to the
feel. The skin is uniformly hot, often red, a little
swollen, disposed to perspire, soft and not dry.
The secretions in general are suppressed. The
urine flows sparingly, often with a sensation of
burning or pricking, and very red, hot and trans-
parent ; the stools hard, dry and sparing. The
patient feels himself weak and cast down, but
there is no impediment to voluntary motion.
Blood which is drawn becomes in a few minutes
milky and troubled, has Uttle serum, and forms a
thick, firm cake, flat, or round and hollow at the
surface, and on which is formed a thick, firm, yel-
low-white inflammatory crust.
As the sketch of these symptoms has appeared
uniform in nature for centuries, observers of all
ages have drawn it in the same manner. Various
modifications, however, arise in the degree of
violence and duration of this fever. The more
violent the whole disease, the more perfect its con-
tinued type; and here either none, or scarcely any
observable remissions take place ; hence the name
c 23 :i
synocha, or febris continua continens inflamma-
toria.
When the fever is less violent, one may remark
distinct remissions and exacerbations ; it ap-
proaches then more to the type of a continued re-
mittent fever, febris continua remittens. In a mild
form, it is properly designated by Hufeland and
Raimann, by the name of irritative fever, (febris
irritativa.) The inflammatory fever is rapid in its
course, and terminates in one, four, seven, or four-
teen days, though it is even sometimes chronic.
The shortest is the febris ephemera, diaria,
which passes off sometimes in a few hours, or
comes to a crisis within twenty-four hours, with
copious sweat, urine with sediment, often with
bleeding at the nose, or with a peculiar eruption
on the lips (Hidroa febrilis.) When it lasts three
or four days, it is called the protracted ephemera,
(ephemera plurium dierum, simpliciter continens,)
or according to some of the older physicians, sy-
nocha legitima. It then enters into the limits of the
synocha extensa (Synochus simplex, synochus non
putris), which extends itself to seven days, from
which it is only distinguished by the degree of
sickness, and the continuance and more violent im-
pression of the causes. — Inflammatory fevers of a
longer duration than seven days, with burning
heat and appearance of the inflammatory crust on
the blood, were called synochus putris by the an-
cients; a source of great confusion, as, from the
longer continuance of the disease, no conclusion
with respect to its nature can be drawn. It may
conveniently be called synocha protracta, and it
may extend its course to eleven, fourteen, or
seventeen days, even in some cases to a longer
period.
c: 24 :
In its course, the synocha terminates in health,
in another disease, or in death. It terminates in
health by crises, which are alone effected by the
vis medicatrix naturae, and which cannot be antici-
pated by art, as we^know of no remedy which will
bring a sediment in the crude urine, or produce
a salutai’y epistaxis ; even sweat, which comes not
spontaneously, but is forced by medicine, is not
salutary, and produces no mitigation. Our art is
able notwithstanding, in many cases, to remove ob-
stacles which retard the crisis, and hence, at least
indirectly, to promote its regular appearance, by
exciting the deficient, and repressing the too no-
lent effects of nature.
The crisis of inflammatory fevers appears in the
ephemera within twenty-four hours, otherwise on
the third, fourth, seventh, or eleventh day ; seldom
on the fourteenth, very rarely on the seventeenth ;
by sweat, urine, bleeding at the nose, sometimes by
an eruption on the skin, and only m a few cases
by vomiting or purging.
An inflammatory fever is seldom, perhaps never,
terminated without some trace of a crisis ; one
cannot pronounce from the beginning what periods
the disease will observe in its course, whether it
will prove an ephemera or a synocha, as this de-
pends on the circumstances of the crisis, ^^'hen
critical appearances take place abundantly, and in
many ways, if a general perspii*ation come on with
a calm sleep, if the urine throws down a furfura-
ceous or rose coloured sediment, and is transpa-
rent above it, if the pulse becomes considerably
less frequent, also soft and quiet, the fever may be
said to be on the decrease ; but should the urine
become clear and of a light yellow colour, if the
heat is moderate, and the pulse quiet, the period
of recovery is already begun.
c: 25 :i
The inflammatory fever passes into other dis-
eases, viz., 1st, by the coming on of local inflam-
mation, particularly of the lungs, the brain, of the
mucous or fibrous textures. As in these cases
the symptoms of morbid activity in the excited
circulation precede, and the inflammation of the
organ is only developed afterwards, the error of
that doctrine is evident, which holds every fever,
without exception, to be the consequence of a
local disease in the frame, and originating in the
morbid affection of an organ. The cause of in-
flammatory fever is not the morbidly increased
activity of an organ but of a system, viz., the san-
guineous, and the augmented formative energy
of the blood* itself; it is not on this account to be
considered as an inflammation of the arteries, for
by actual inflammation the action of the affected
part would be impeded ; but in synocha, the ac-
tivity of the sanguineous system is increased, and
is hence in a state of inflammatory irritation, but
not of inflammation — which, indeed, in so essential
a part of the body coidd scarcely be suffered.
One has only to consider the serious symptoms
which inflammation of individual arteries produce,
viz., violent pulsation and excruciating pain in the
affected part, and in inflammation of the aorta,
the greatest restlessness and anxiety; the extreme
hard pulse, the violent pulsation of the heart, the
beating of the carotids ; the sensation of ardent
pain, w hich symptoms must necessarily appear in
much greater number in inflammation of the
whole system : and we shall no longer incline to
this opinion. 2d, by transition into another sort of
fever, viz.(rt)into the gastric character, w'ith which
* Rildungstrieb des Blutes.
D
n 26 ]
indeed most inflammatory fevers are accompanied.
The morbid derangement of the organs of diges-
tion by the fever, the interruption to the secretions,
the privation of nutriment, its insipid quality, the
’.vant of motion, even the kind of medicines can,
without errors in diet, only have a prejudicial
influence on the digestive organs. It is gene-
rally of a mild kind, and vanishes by a return of
the digestive powers : according to circumstances
it may be saburralis or bilious, if those disorders
are prevalent ; with children it is often connected
with worms, (b.) Into the nervous character.
This change takes place either through the unfa-
vourable constitution of the patient, in persons of
weak habit of body, as also in those who have been
given to drinking ; by the prevailing character of
the other fevers, by errors in regimen, or by the im-
proper use of remedies. In most cases I observed
this to happen where the patients from the begin-
ning had used strong purgatives ; many of the
common domestic purges being in their nature
drastic, numberless diarrhoeas were produced, and
the animal powers quite exhausted. The nervous
symptoms appear usually about the period of the
critical days ; those of crisis do not happen in the
appropriate manner or number. These are
heaviness and stupor in the head, vertigo, partial
loss of consciousness, occasional wandering, tin-
nitus aurium, the tongue is first in the middle,
then throughout dry; it is red, or has a white coat,
remains but a short time moist after drink without
becoming dry again, often trembles when put out ;
the thirst is either very moderate, often less than
natural, or very great, not to be quenched bj'
drinks ; the respiration is deep and frequent, often
attended with a peculiar hissing noise; this may
C 27 3
doubtless be occasioned by the presence of an in-
flammation in some part of the lungs ; yet this
kind of breathing is the consequence of desicca-
tion of the mucous membranes, and disappears
onh"^ after the crisis ; the cough is dry ; with a
frothy expectoration, often marked with blackish
streaks of blood, often also intermixed with florid
blood ; which, when connected with an impeded
deep inspiration, indicates an inflammatory state
of the lungs. The belly is swollen, sounds when
struck, is either without pain, or attended with a
darting pain on handling, and is then accompa-
nied with contraction of the muscles of the face.
The stools are liquid, the consequence of the in-
sensibility, or of the irritable state of the intes-
tinal mucous membrane ; the urine is deep red,
crude, without a cloud, and often for a long time
very hot. The pulse quick, small, and weak ;
during the exacerbations, on the contrary, hurried,
tense, and sometimes hard. Hence arises from
this change in the synocha, a true inflammatory
nervous state, in which traces of both the inflam-
matory and nervous character are to be found ;
during the exacerbations the inflammatory, dur-
ing the remissions the nervous character prepon-
derates, which, in the treatment, is of the most
essential consequence to be attended to.
Should symptoms of admixture of the humours
come on at the same time with these appearances,
the putrid character is established ; this happens
more especially when foreign matters, which are
capable of chemical admixture, have been retained
in the system. The synocha, by itself seldom
terminates fatally ; though this may happen from
its being of a more violent character, by a total
neglect of proper, or by an improper treatment of
c: 28 3
it ; it may end in apoplexy, or by passing into
some other disease. The treatment of inflamma-
tory fevers must be proportioned to the degree
of their inflammatory character, that is, more or
less decidedly antiphlogistic ; their violence in
this year was not, however, so decided as to ren-
der general blood-letting necessary. In one case
it was superseded by a spontaneous bleeding at
the nose. Nitre was otherwise the chief remedy,
and was usually given from half to a whole drachm
in half a pint of the decoction of marshmallow
root, and produced the desired effect. Costive-
ness was relieved by glysters, or when these were
insufficient, by neutral salts ; as Potassae tartras,
or supertartras ; Magnes. sulphas, or Sodae sul-
phas. Eight cases, without an exception, passed
off with this treatment and a strict diet, regu-
larly and fortunately : those worthy of remark
shall be mentioned.
FEBRIS INFLAMMATORIA PROTRACTA.
A priest, of a strong habit of body, and
having hitherto been in good health, was taken
with violent shivering, succeeding heat, and vio-
lent pain in the head, without any assignable
cause. Complete depression of strength and rest-
lessness obliged him on the fourth day of his ill-
ness, the 31st of January, to seek relief in the
general hospital. His countenance was flushed,
his eyes sparkling and animated, the tongue coat-
ed in the middle with a dark brown crust, his ap-
])etite gone, his thirst very great, his breathing
quite natural, pain in the spine, the urine clear
and high-coloured ; there was costiveness, in-
creased heat of the skin, the pulse somewhat fre-
quent, full, and tense, without being hard. The
C 29 3
following was prescribed ; — Rad. altli. ^ss; coq. s.
q. aq. per hor. col. 5'iU* 5®® 5
alth. 5ss. siimat. cocb. duo secundS. qufi^que bor& ;*
crude barley, boiled with liquorice root, and an
emollient glyster was ordered.
On the 1st and 2d of February, this remedy
was continued with few interruptions ; on the 3d
of February, which was the seventh day, a crisis
was looked for, yet the urine continued crude ;
the fever continued ; in the night he had several
loose stools without relief, hence the nitre was
discontinued. On the ninth day, for the first time,
a copious yellow-red sediment was formed in the
urine, the pulse was undulating and somewhat
frequent. In the evening a general perspiration
took place, his headache had entirely disap-
peared, and in its place a dry cough had come on ;
in addition to the Dec. alth. cum Syr. alth. he had
an emollient linctus composed with Muc. acac. and
Syr. comm, ordered, and for his drink a decoction
of salep. The costiveness now returned, for
Avhich pot. tart. 5ij. were added to the decoction
of marshmallows ; he continued to use this to the
twelfth day; and on the 10th February ho left
the clinical ward cured.
A second case presented itself in a turf-digger,
twenty-two years old. This man was seized with
cold, from exposing himself when heated in a cold
room ; it lasted some hours, to which a general
heat succeeded ; and as he expressed himself, his
skin burnt like fire. Headache and increased
thirst now came on. During this he had twice a
copious hmmorrhage from the nose, by which he
* 'Phis direction is to be understood as general, when no other
is particularized.
0 3
[; 30 3
felt himself relieved. After being four days in
this state he came into the clinical hospital. The
symptoms were nearly those of the former case ;
the countenance was swollen and flushed, the
eyes twinkling ; pain over the root of the nose,
the tongue was white, the heat of the skin very
much increased ; the bowels for some days con-
fined, the urine very hot, the pulse frequent, full,
and somewhat hard.
Ordered, Aq. comm, ; Pot. supertart. 3ij ;
Test. pp. 5j ; Sacch. pur. 3ij. (Enema emoUiens.)
On the 22d ol March there came on a moderate
bleeding of the nose, which was expected, and
which returned on the 24th ; the head was now
free, the countenance less flushed, the pulse more
quiet : he went on with his mixture for some days
wuthout interruption ; moderate evacuations, a se-
diment in the urine, and a moderate perspiration
took place, the pulse became soft, and the urine
by degrees of a straw' colour. Thus the fifteenth
day of the disease arrived ; the patient had no
complaint, the appetite and the digestive powers
were, however, still very imperfect, for which he
had ordered* Rad. caryophyllat. 3iij inf. s. q. Aq.
ferv. p. 4: hor. col. Jvj. adde Ext. cent. min. 3ss.
After he had taken twice of this remedy, the ap-
petite increased, and soon became absolute hun-
ger. By an uninterrupted care m his regimen, he
went home cured, on the 29th of March.
A third case of inflammatory fever was that of
a servant maid, twenty-eight years old, who
otherw ise enjoyed uninterrupted health. In her
twenty-fifth year, her menses ceased, without her
being able to assign a cause; she was without
• Gei urbaui Rad.
c: 31 :
them for a whole year, without suffering any in-
convenience on that account ; in her twenty-sixth
year they returned spontaneously, and observed
their regular periods. On the 21st of March she
caught cold during her period, they disappeared
almost instantaneously, and the same evening she
experienced lassitude and cold, followed half an
hour afterwards by heat ; she was very restless
during the night and feverish. On the third day
of her illness, she came into the clinical ward,
with symptoms of inflammatory fever ; the coun-
tenance swollen, and of a lively red colour, burn-
ing heat, increased thirst, a frequent and full,
though not a hard pulse. The tongue had a
whitish coat, and was dry, the bow'els confined
for the last two days, though previously they
w’ere relaxed. The remedies ordered were Dec.
alth. cum Pot. nit. et Oxymel. and Dec. hord. Oij;
Acid, tartar, gr. xij ; Sacch. pur. 5ij. pro potu.
March 25th. She has passed the last night in
very restless sleep, the headacb.e continues, the
countenance flushed, the mouth full of viscid
phlegm, the urine very hot, the pulse frequent
and full, though not hard ; now and then she
had attacks of vertigo and tinnitus. On the 27th,
she had perspired abundantly during the night,
and found herself relieved. On account of the
continued affection of the head, she had a blister
applied to the neck. On the 28th, she slept some-
what during the night, and felt herself very much
better, she perspired copiously. On the 29th
(the eighth of the disease) the urine threw down
a whitish grey mucous sediment, and her appetite
returned. On the 30th, on account of deficient
alvine excretion. Soda? sulph. 3ij. were added to
her mixture ; her recovery now advanced without
i: 32 2
interruption. On the 5th of April, she returned
to her place cured.
CATARRHAL FEVER.
There was only one case of simple catarrhal
fever taken into the clinical ward ; catarrhal affec-
tions generally come on so extensively, that they
belong to the most common diseases, and are
often epidemic, yet are they seldom an object of
practice in establishments for the sick. Their
easy course, and the little inconvenience which
they occasion, make the domestic treatment of
them feasible. It is to be regretted that proper
care of these apparently mild affections is seldom
taken ; hence their not uncommon long continu-
ance, of which the consequences are but too se-
rious, for without doubt the most common and in-
curable consumptionSjfrom tubercles in the lungs,
have neglected catarrhs for their cause : hence
Tissot’s conclusion, that by catarrhs more per-
sons are carried oft’ than by the plague, however
it may appear exaggerated, comes very near the
truth. The obituaries of great towns and their
hospitals offer (he most valid proof of it; for from
these it appears that a fifth part of the human
race is carried oft’ by consumption. And when
it is granted that hereditai-y predisposition,
neglected inflammations of the lungs, hemopty-
sis and scrophula, are also very efficient causes
of this disease; still the above mentioned neglected
catarrh, to w'hich every age, mode of life and habit
of body is exposed, is by far the most frequent.
Hippocrates also places consumption among the
popular diseases, and it follows that he meant
that which is the cft’ect of catarrh, as he re-
presents it as the consequence of cold and moist
c: 33 ;]
weather. — At all events, such conclusions justify
the maxim, “ every pulmonary catarrh should be
carefully attended to, and we should not hold
light any one that has been neglected.” A
moderate temperature, the avoiding stimulant
food and drinks, quiet, and the use of mucilagi-
nous soothing remedies and vapours are indispen-
sible in the treatment of simple catarrh ; when
violent, venesection must be had recourse to. Old
catarrhs require, so long as there is any inflam-
matory tendency, rather emollient remedies, and
small repeated venesection, with revulsive appli-
cations ; and they must, so long as the cough
lasts, be treated with great circumspection and
perseverance. The present case passed into the
nervous state : it occurred in a young woman
fifteen years old, and of rather a robust habit ;
she was seized with a cough and fever, and on
the 25th of January, (being the thirteenth day of
her illness) came into the clinical hospital. She
complained of violent pain in the forehead, the
countenance was flushed, the eyes protruding, the
nose and mouth dry, the tongue white, the thirst
great, a sense of tickling in the throat, mth con-
stant irritation and a dry cough ; the voice hoarse,
the breathing difficult from a sense of constriction
on the breast ; the bowels free, the pulse full,
tense, and rather hard. Ordered four leeches to
the breast, and afterward emollients fomentations.
Dec. R. Alth. ^viij ; Ammon, muriat. gr.xij ; Roob
sambuci.3ss. After the use of leeches the breathing
was relieved, the headache became less violent,
yet the mouth and tongue remained dry, the
thirst great, a yellow expectoration took place,
the urine was yellow, with a mucous sediment, the
pulse moderately frequent and soft. As on the
c: 34 ;]
seventeenth day, the evening exacerbation came
on with increased headache and wandering stitches
in the breast, a blister was laid on between the
shoulders. On the eighteenth day she had many
loose stools, the cough was moderate, the inspira-
tion somewhat confined ; she had wandering pains
in the chest ; though on breathing deep the cough
was not excited ; the urine had a reddish colour
with floating clouds, the pulse was quick, full and
soft. She had a blister to the breast, and night
and morning one-sixth of a grain of Ipecacuanha.
On the nineteenth day there came on a sense of
burning in the stomach and oesophagus, which
went off by her bringing up a large round woiin ;
in the evening she had more fever, the face
was flushed, the headache violent, the cough very
moderate and moist ; the pulse frequent, tense and.
hard ; she had a stool resembling boiled meal.
She had ordered. Mist, amygd. cum Pot. nit.
She was better on the following day, but on the
twenty-first, in the night, there came on a con-
tinued wandering, the headache was milder, the
countenance was pale, but her cheeks had a cir-
cular flush, the cough continual, attended with a
little yellow coloured expectoration, the skin dry
and hot, the urine turbid, with considerable sedi-
ment and vitreous surface, the pulse equal, suffi-
ciently strong and soft. Notwithstanding the
critical urine on the twenty-first day, there was
yet no critical perspiration, and the coming on of
the unpleasant symptom of wandering threatened
the approach of the nervous stage, with inflam-
matory irritation of the brain ; four leeches were
applied to the breast, and the Dec. alth. cum Am-
moniac muriat. repeated ; during the day she did
not wander, but at night this took place with a
c 35 ;]
heaviness of the head, whence two more leeches
were applied on the temple at bed time. On the
twenty-second day, a refreshing sleep followed ;
the headache and pain of the breast disappeared,
the look was lively, the cough mild, with an easy
and no longer coloured expectoration ; she had two
stools, the urine was of a straw colour, the pulse
less frequent and tolerably strong. Now the mor-
bid symptoms diminished gradually, the tongue
became clean, the cough disappeared entirely, the
appetite returned. The patient took her medi-
cine for three days longer, and was discharged
cured, on the 11th of Februai’y.
RHEUMATIC FEVER.
Rheumatic affections with and without fever
prevail so extensively, that they belong to the
most common, and as well as arthritic complaints,
to the endemic diseases of our city.
The number of cases treated in the clinical
ward was eleven, besides which there came many
rheumatic cases connected with local inflammations
as incidental circumstances. The great changes
in the weather, the hilly situation of the city, which
admits of the easy access of the north, north-west,
and south-west winds, and the constant currents of
air, contribute much to their frequent appearance.
For rheumatisms are produced especially by
draughts of air, cold, moisture, and getting chilled.
The numerous class of servants who apply for re-
lief in hospitals when attacked with sickness, are
especially subject to rheumatic affections, as these
men very generally, when the body is in a state of
perspiration, are wont to expose themselves to the
cool air, when heated from hard work and in a
light dress ; or in winter, they sit in hot stoves, and
i: 36 ]
then suddenly betake themselves to the cold at-
mosphere ; the occupation of the laundress too,
gives numberless occasions of taking cold.
Among the various forms of rheumatism, the
acute is the most common, which is attended by a
more or less inflammatory fever. The pain is
lancinating, pungent or burning, increased by mo-
tion ; in very acute cases, there is redness of the
part, with tumour and heat. It often leaves the
part affected and goes to another ; should this be
inward, great danger is to be apprehended. The
fever is always at the beginning, if not a genuine
inflammatory one, at least a state of irritation ; in
the course of the disease, it may doubtless be
joined with one of a different character, or pass
into it entirely. When the fever is inflammatory,
the treatment must be antiphlogistic, and this will
alone at the same time promote diaphoresis ; all
the so called exciting diaphoretic remedies, which
merely bring on sweat, make the case worse at the
beginning. If the patient is plethoric and strong,
the fever violent, the pulse full, tense, and hard,
blood-letting is indicated. The blood also forms
in this case a thick inflammatory crust. — On the
contrary, should the local affection be most con-
spicuous, then leeches or cupping in the neigh-
bourhood of the part is advisable ; lukewarm
mild infusions, nitre in small doses, Roob and Syrup
of elder, taken inwardly, are beneficial. Should
there be any gastric affection connected with it,
then [muriate of ammonia, or in its place, Liq.
antim. tart ; and only when the fever has become
milder, can we give Liq. amm. acet; Flor ; Samb.
Stipit. dulcamarae; Aconitum; Sulphur, ant. praccip.
Guaiacum and camphor are only useful in chronic
rheumatisms without fever. It often happens
: 37 ]
happened that the rheumatic humour fixed itself in
some place, and there obstinately continued ;
when all fever and inflammatory irritation was
gone by, bhsters were employed ; they were kept
on so as to produce their full efiect, and they ge-
nerally soon removed the pains. Externally,
rheumatisms do not bear warm moisture, but folds
of tow, flannel, or sear cloth must be used. It is only
when absolute inflammation is connected with them
that they bear emollient fomentations or vapours,
which often procure great relief. — In confirmation
of which, the following cases are specified : —
Eliz. Palexkin, thirty-two years old, a cook, was
exposed to cold, by going in mid-winter into the
cold air when heated, from which she was seized
almost instantly with cold alternating with heat,
and wandering lancinating pains in the shoulders
and arms. On the 15th of November, she came
into the clinical hospital. She felt pain in the
forehead, a sense of burning in the eyes, the
topgue had a white coat; on a deep inspiration
she felt pungent pains in the left side, the epigas-
trium too was painfully tender ; the pain ex-
tended to both shoulders and arms, the skin per-
spired little, was somewhat warm to the touch, the
urine high coloured, the pulse moderately frequent
and full. Ordered. R. Gram. 5j; coqueper:5 horas
Col. adde Roob Samb 5ss. On the 17th
the symptoms of the local affection and the fever
had somewhat abated, the pungent pain of the
left Pleura still continued, for which an emollient
cataplasm was ordered ; the rest as before. On
the 19th, a crisis of the fever shewed itself in the
urine, but the local affection, the violent pains
in the shoulders and arms, remained the same.
Liq. ammon. acet. was added to the former
E
C 38 3
medicine, and the arms enveloped with flannel.
A copious perspiration soon followed, after which
the pains subsided.
On the 22d of November, there came into the
clinical ward a servant-maid, nineteen years old,
who had already been several days ill at home,
she had violent headache, wandering pungent
pains in the shoulders, a bitter taste, frequent and
tolerably strong pulse, she had a strong and dr)-
cough, but she could make a deep inspiration with-
out pain. She took Mist. amyg. cum Pot. nit. and
Sacch. She perspired greatly, and the bowels
became costive, whence Dec. Gram, cum Pot. tart-
was given. The urine deposited a copious sedi-
ment, and a corresponding evacuation was pro-
cured by glysters. Up to the 28th, the patient
w as quite free from all pain, and left the hospital
on the 30th of November.
FEBRIS RHEUMATICA IN INTERMITTENTEM
TRAKSIENS.
Eva Kauba, a maid-servant, tw'enty-six years old,
of a stout make, exposed herself while employed
in w’ashing to the cold, and w^as seized with
w^andering violent pains over the whole body ;
she had a sense of oppression on the breast, with
a constant inclination to cough, the respiration
itself was not much impeded ; she was admitted
on the 28th of December, wdth these symptoms ;
the pulse was frequent and full, but soft; Dec. Alth.
cum Nitro, and a blister to the sternum. Already,
on the following day oppression was less, but the
fever continued somewhat violent. On the 2d of
January, the patient complained of colic pains in
the belly; it w'as the time of her menstrual period ;
the nitre w\as omitted, and in its stead Potass.
i: 39 3
tartras added. She took some chamomile tea,
and had warm cloths applied to the abdomen, by
which the pains were immediately relieved. On
the 4th of January, towards evening, she experi-
enced very great cold, to which heat and a gene-
ral perspiration succeeded ; these paroxysms re-
turned daily at the same hour ; the pains however
had entirely ceased ; Infus. Caryophyllat. cum Am-
mon. muriat. was ordered ; and after she had taken
it eight days, the febrile paroxysms disappeared.
On the 14th, she found herself well, and without
any remains of her complaint ; she went home on
the 18th of January.
FEBRIS RHEUMATICA DIVERSiE FORM^.
Anna Kruschmann, a maid-servant, twenty-
eight years old, was likewise, from exposure to
cold w’hilst engaged in washing, seized with a
violent pain occupying the left shoulder. When
she came under our care, the fever was also
violent, and the skin dry ; she took Dec. Ath. cum
Nitro et Roob Samb. The fever soon became less
violent, but the local pains remained nearly as
before; Linim. ammon. cum Camphora was ordered
to be rubbed in, and to take an infusion of elder
flowers, with Antim. tart, grss ; a general perspira-
tion took place, by which she lost all her pains.
A servant-maid, Franciska Ziinger, was attacked
after a sudden exposure to cold when heated, with
violent headache and fever; Dec. Gram, cum Nitro
et Roob. Sambuci, and a blister to the neck soon
relieved her. The fever terminated critically by
urine and perspiration, and with it all her ail-
ments disappeared.
Josepha Shubeck, a maid-servant, twenty years
old, of a robust make, was seized after washing
C 40 ;]
linen, with violent pains in the upper extremi-
ties, and a drawing unpleasant sensation in the
neck, she was languid and alternately hot and cold.
\Vhen she was admitted, she complained of head-
ache, darting pain of the ear, bad taste; the
tongue had a dirty white coat ; in the region of
the stomach she felt a compressing pain, the ab-
domen was tense, she had for four days no evacu-
ation, the pulse was frequent and tolerably strong,
she had ordered Dec. Gram, cum Sodae sulph. et
Roob Samb. aa ^ss ; and an emollient glyster. On
the following day, she found herself much better :
she had had a copious evacuation, for some days
she continued the same remedy ; there came on
a profuse perspiration ; the urine threw down a
sediment, and after ten days she left the hospital
cured.
Catherine Sacher, a maid-servant, twenty-four
years old, without her being able to assign a cause,
except that for three months she had lost her
periods ; was seized with shivermg and fever, with
continued headache and pains in the limbs. On
the 3d of June, she came into the hospital: the
fever was moderate, the tongue coated, the bowels
relaxed ; Dec. Alth. cum Ammon, mur. et Roob
Sambuci. On the following day she complained
of a pungent pain in the region of the liver, which
was sensible to the touch, but not enlarged ; for
which warm fomentations were ordered. The
patient had every night profuse perspiration, and
during the day there was moisture on the skin.
On the 8th, she probably got chilled in going
to the closet ; she began to have a dry cough,
and complained of pungent pains in the ears. She
had Dec. Lini cum Ext. Glycyrrh, and was ordered
to bind a light handkerchief round the head. On
l: 41 3
the 11th, the menses unexpectedly made their
appearance. As the pain in the ears did not di-
minish, a perpetual blister, of the size of a shilling,
was applied behind both, with which this symptom
was removed, and on the twenty-second day she
left the hospital cured.
TEBRIS RHEUMATICA CUM PLEURITIDE.
The following case shows what very dangerous
forms acute rheumatism sometimes assumes, when
it attacks an inward part: — A tailor’s wife, forty-
nine years of age, and lax habit of body, was after
a very violent emotion of the mind attacked with
cold and heat, to which were soon joined very
sharp pains in the limbs, and along the back ; these
were milder on the third day, but now wandering
pungent pains attacked the breast, which rendered
breathing very difficult, and were quite intolerable
when she coughed or made a deep inspiration ; the
head was painful, the countenance pale, the skin
moderately warm, the pulse frequent, somewhat
hard, very contracted and small ; in this state she
came on the oth day into the hospital. Venesection
to eight ounces was employed, (the blood formed a
thick cupped crust) also emollient fomentations to
the breast, glysters and Dec. Alth. cum Nitro and
Syr. althaeae. The venesection was on the follow-
ing day repeated, as the violence of the symptoms
continued. On the third day six leeches were
applied to the part where the greatest pain was
felt. On the fourth day a decidedly bilious state
came on, the conjunctiva and the skin of the face
were remarkably yellow, the tongue was covered
with a thick yellow slime, the taste was pasty, the
headache increased, particularly affecting the
E 3
c 42 :]
forehead ; the patient, moreover, complained of a
heavy pain in the right hypochondrium, which
did not bear pressure, and appeared somewhat
swollen ; the pains in the breast had disappeared'^
ordered, Dec. Graminis. cum Potass, tart. 5ij ;
emollient fomentations w'ere applied to the pain^
parts, together with six large leeches, which were
repeated on the following day. The fever did not
admit of venesection. The pain in the region of
the liver was soon dissipated, but now the patient
began to complain of violent headaches, they were
insupportable at night, she would not remain in
bed, she found no where rest, and had even pains
on applying the hand to the scalp, yet she bore
the impression of the light without inconvenience ;
the pulse was very frequent, hard and oppressed ;
blood was taken to six ounces. Leeches ap-
plied to the temples, and a powder containing
half a grain of calomel given every three hours.
On the following day she was something better,
towards evening the pains of the head increased,
and six leeches and a blister were applied to the
neck. As frequent loose evacuations by stool had
come on, a thick decoction of salep, with Ammonias
mur. gr. xij. was exhibited, and one-third of a grain
of Ipecacuanha, added to the calomel. Her state
was after this more tolerable,yet she began to cough
with more violence, had oppression at the chest,
could not on account of a pain there lie on the left
side; expectorated a tenacious, saffron-coloured
mucus, the tongue was covered with a thick slimy
coat, the pulse still remained quick, full and hard ;
venesection to 5'T was again employed, the blood
was covered with an inflammatory crust ; the urine
continued still high coloured, and trotibled. The
oppression at the chest abated, the pain continued,
C 43 ;]
six leeches twice applied, and a large blistering
plaster entirely removed the pain. Meanwhile she
returned to the Decoct. Alth. cum Nitro, and calo-
mel was given, combined with digitalis. On the 22d
day the urine deposited for the first time a dirty
white mucous sediment, the skin till now dry, be-
gan to perspme freely, so that she was bathed day
and night in sweat. After this complete crisis
by sweat and urine, no untoward circumstance
occurred, to disturb her noAv pretty rapid reco-
very.
GASTRIC FEVERS.
Eight cases of gastric fever were treated ; a gas-
tric state was, however, frequently seen connected
with other complaints ; this complication was ob-
served very frequently in the hot summer months
of this year, when it declared itself as decidedly
bilious. For the most part the patients came to
us in an advanced stage of the disease, hence
there was seldom occasion for emetics. Mild, sok
vent, eccoprotic remedies had always the best
effects ; where diarrhoea was present, muriate of
ammonia was employed in small doses, and Ipeca-
cuanha as circumstances required. It very often
happened that from neglect, especially when ex-
cessive diarrhoea from the beginning had exhaust-
ed the patient, he fell into the nervous or putrid
state, and into imminent danger. This state was
opposed by the Arnica root, which in such cases,
especially where the diarrhoea still continued, had
an excellent effect, with Caryophyllat. Ipecac. Mu-
riate of ammonia in small doses and Columbo. If
the powers sank, strong restorative means were
employed, such as Angelica, Cinnamon, Cascarilla,
C 44 ;]
Camphor, ■\vith external irritation, as indicated by
the nervous and putrid character of the disease.
FEBRIS SABURRALIS.
A hatter, thirty-two years old, had many years
ago an obstinate intermittent fever ; on the last
day of January, 1823, he eat some fat meat, after
which he passed a restless night ; he felt on going
to bed a sensation of cold, which became a slight
shivering ; he had headache, unusual pressure at
the prsecordia, and loathing of food. On the third
day of the disease he came into the hospital, the
taste was bitter, with eructation, as after eating
unsound eggs, the tongue coated, he had colic
pains, the belly was swollen and pasty to the feel ;
he had had two loose stools, the urine was turbid,
he complained of great depression, the pulse was
frequent, full and soft; he had ordered Dec. Gram.
5viij. Sod. sulph. Mellaginis graminis a jss. On the
following day three very foetid evacuations took
place ; in other respects the symptoms were the
same though not so violent. No alteration was
made in the treatment, copious evacuations fol-
lowed daily, the abdomen subsided, the headache
as well as the oppression at the stomach disap-
peared, the urine deposited an argillaceous sedi-
ment, the taste became natural, yet the appetite
was deficient. Bitters were now had recourse to,
and the following prescribed. — R. Calam. arom.
3iij. f. Inf. ferv; Colat adde Ext. Marrub;
alb. 5ss. Spt. aether, nitricisj. For three days the
patient used this remedy and was much better;
the appetite returned, the stools were regular, and
after being eight days in the hospital, he went
away perfectly well to his occupations.
L 45 3
PEBRIS SABURRALIS CUM TUSSI.
A stout maid-servant, nineteen years old, on
the 13th of April had eaten sour-krout, to which
she was unaccustomed ; she soon felt indisposed,
wth oppression at the stomach, and aversion to
food, she had shivering and loss of strength. On
the 15th, she came into the hospital; since she
was first taken ill, she had had no evacuation by
stool, the tongue was white, the taste bitter, great
thii’st and constant oppression at the stomach.
She had a hard and dry cough, a deep inspiration
gave no pain, the pulse was quick and soft. She
had Dec. Tarax. cum Sodae sulphat. Jss. also an
emollient glyster. On the 18th her state had
much improved, there had been some slight
evacuations, the oppression at the stomach was
less, the tongue was cleaner at the point and
edges ; still she coughed with violence, and had
frequent sour eructations. Aq. commun. 3X1 >
Pot. supertart. 5ij. Test, praep. 5j. Sacch. purif.
3ij. By the 23d, the material symptoms had
disappeared : yet now the cough came on with
increased violence in sudden attacks, which by
degrees became stronger and more continued ;
it tormented her day and night, and brought on
pains in the chest ; the pulse did not indicate
fever. Decoct Sem. Lini cum Ext. Hyos. gr. iij.
Vesicator. Sterno. This was continued for some
days, but as the cough by the 28th had not
much diminished, and was dry, and the patient
complained of much pain from coughing, she
was ordered Sem. papav. alb. 3^3 ^^.t lege urtis
cum Aq. commun. Emulsio, Colat. 3viij* adde Ext.
Opii aquos. gr.j. Sacch. pur. jij. Four cup])ing
glasses with scarification were applied to the
n 46 ;]
chest. On the following day a blister was placed
between the shoulders. These means had in the
end the desired effect, the cough became milder,
less frequent, and then ceased ; quiet and sleep
returned. She had now only the simple Decoct.
Lini ordered. On the 4th of May, she left the
establishment quite weU.
FEBRIS INFLAMMATORIA GASTRICA COM ANGINA
TONSILLARI.
Gottfried Grohmann, a student, eighteen years
of age, felt himself, on the 5th of July, without
being able to assign a cause, uncommonly cast
down and stupified ; he had headache, frequently
on a sudden he became faint, with alternate heat
and cold ; pain and difficulty in swallowing came
on with restlessness. In this state he was on the
second day of his illness brought into the hospital.
His countenance animated, flushed, the eyes ghst-
ning, the taste slimy, the tongue had a thick white
coat, the appetite gone, the mouth inflamed, and
the tonsils considerably swollen. In the region of
the stomach he had a sensation of a dull pain, it
was sensible to the touch, the abdomen tense, he
had had a stool, the urine was of a dark colour, the
heat of the skin increased, the pulse frequent and
strong. The treatment consisted in the employ-
ment of four leeches to the neck. Decoct. Grami-
nis cum Potass tart, and Mellag. Gram, together
with an emollient gargle and fomentation.
On the 9th, the inflammation in the throat had
greatly subsided, the fever was moderate, and the
gastric symptoms less urgent. Instead of the Pot-
ass® tartras, the Pot. supertart, was added to the
decoction ; and as he had had no relief for tw'o
days, glysters were employed. The evacuation
c: 47 ;]
was scanty and hard, hence Dec. Gram, cum Sodas
sulph. and Ext. Gram, was ordered, from which
some easy evacuations took place ; the morbid ap-
pearances gradually disappeared.
On the 14th, the eighth day of his being in the
hospital, he left it recovered.
FEBRIS GASTRICA SABURRALIS, DEINDE NERVOSA
PUTRIDA, CUM INTUSSUSCEPTIONE INTESTINORUM.
The case of Anthony Sidel, a student in sur-
gery, had an unfortuate issue, and the post mortem
examination was interesting. This young man by
errors in diet had brought on a gastric fever ; he
used at his own suggestion the vitrum antimoniale,
which passed downwards and brought on a violent
diarrhoea, so as to cause ten or fifteen evacuations
daily; three entire w'eeks elapsed in this state;
at length he came to us with the appearance of a
nervous puti’id fever ; the head much affected
with stupor, ringing in the ears and deafness;
his countenance w’as pale, the eyes sunk, the
tongue dry and covered with a brown crust, tre-
mulous, and with difficulty brought forward ; the
speech heavy, the abdomen not painful, collapsed,
the diarrhoea still continued, and at last the stools
came away spontaneously ; the skin was dry to the
feel, the pulse weak. For this state the restora-
tive method was employed; but the chief object
was to put a stop to the excessive diarrhoea ;
hence, Rad. Arnicas, Angelica, Aq. cinnamom.
united to mucilaginous remedies, particularly to
the Mucilago acaci®, Salep, Rasur. Cornu Cervi ;
with red wine ; Ipecacuanha in small doses, and
taken when the powers began to sink, Camphor,
Liq. ammon. subc. Castoreum and Moschus, were
had recourse to ; the patient however died in the
c 48 ;]
third week after his admission. On opening the
body, contrary to all expectation were found (what
most rarely occurs in examinations after death,) no
less than seven intussusceptions, all which were
from above downwards, and each of them occupy-
ing half a foot of intestine ; the bowels were more-
over quite empty, the upper intruded parts of the
gut were much inflamed and red, and w'ere with
some difficulty drawn out. How such cases are to
be made out by strict diagnosis, and when so deter-
mined, what treatment should be adopted with
hopes of success, remains a problem, the solution
of which would be highly interesting to medicine
in its present state.
HYDROCEPHALUS ACUTUS CUM INTUSSUSCEPTIONE
INTESTINORUM.
As we are now treating of the intussusception
of the intestines, a case deserves to be presented,
which (extraordinary as it was) was admitted into
the hospital in the same week.
A boy, fourteen years old, whose occupation
was the playing on a wind-instrument, was ad-
mitted on the ninth day of his illness with delirium,
stupor, a very dilated pupil, and strabismus : he
had also some inflammatory affection of the intes-
tines ; he complained of a fixed pain in the belly,
opposite the lumbar vertebrae, and when much
pressure was made in the umbilical region, he
gave signs of pain by contracting the facial muscles,
the bowels were confined, there was frequent vo-
miting, but this did not immediately follow the
taking of his medicines ; he had much fever. The
case was considered an inflammatory dropsy of the
head, -with accompanying enteritis ; topical bleed-
ing, emollient remedies, calomel, &c. were employ-
C 49 n
ed, but it ended fatally. On examining the brain
and exposing the parietes of the ventricles, the
water therein contained protruded them like a
pouch upwards, they were full of effused lymph ;
on the surface of the brain, and its membranes,
the vessels were very much developed ; the thorax
was in its natural state, and so much more was
our curiosity excited on opening the abdomen,
to know the cause of the deep seated pain, the
seat of which could not be with certainty deter-
mined. For a long time nothing unhealthy was dis-
covered, till, at length, on separating them, an in-
tussusception was observed in the small intestines,
which was at least two feet long ; the inferior
portion of the gut was thrust into the upper ; it
was in this place inflamed ; who could here have
suspected the d'sease — and how could the patient
(even if the dropsy of the brain had not been
present) by a well directed treatment have been
saved ? We are hereby taught how difficult it is
to decide in many cases of importance. The
vomiting which preceded was equally a symptom
of water in the head as of inflammation of the
intestines, especially when there is accompanying
pain, and yet it was here doubtful to which mor-
bid state it properly belonged. It deserves to be
noticed, that the before mentioned patient who
had the intussusception from above downwards,
suffered from an exhausting diarrhoea which
could not be stopped ; the present case in which
the intussusception was from beneath upwards,
had frequent vomiting after an apparently obsti-
nate costiveness.
F
[; 50 ;]
BILIOUS FEVER.
Bilious fevers happen frequently in Prague,
particularly in the hot seasons. They are easily
known by the yellow tinge of the countenance, by
a similar covering and roughness of the tongue,
bitter taste, great thirst, eructation or vomiting of
a yellow, green, or black bile ; tension and op-
pression about the liver, dark red, or deep saf-
fron- coloured urine, which stains linen yellow’ ;
copious bilious stools, and a peculiar sour smell
of the perspiration. In most of the cases, at least
in our time, there is very considerable irritation,
or even absolute inflammation accompanying it.
In the treatment this is to be particularly regarded,
and hence it appears why the indication of
emetics is at present much less frequent than
formerly ; the prevailing type of diseases is now-
a-days more of an inflammatory nature. By vomits
this would be onlj’ increased, and the affection of
the liver artificially changed into absolute inflam-
mation of that viscLis. Hence antiphlogistic, open-
ing, and acid remedies, as Gramen, Tamarinds,
Potass, supertart. vel. tartras ; Lemonade, vinegar
and water, oxymel, and acid fruits, are attended
with the best effects. Should the inflammatory
affection gain ground, and there appear a deter-
mination of blood to any particular organ, topical
blood-letting is indispensible, bleeding from the
system is only to be employed when the inflam-
mation has attained a high degree, and even then,
with great precaution, since, by an indiscreet use
thereof, it may easily pass into the typhoid cha-
racter.
c: 51 D
FEBRIS BILIOSA ET AMExNORRHCEA.
Anna Eberle, a servant-maid, of a lively cha-
racter, nineteen years old, came, on the 24th of
June, into the hospital, after having, by putting
herself into a violent passion, and taking much
cold drink, brought on fever three days before.
She complained of an oppressive pain in the fore-
head, her face was hot, with a red circumscribed
Hush on the cheeks, having somewhat of a yellow
tint, the eyes glittering, the tongue covered in the
middle with a whitish yellow coat, the taste bitter,
as also the eructation; great thirst, fulness and
pain in the region of the stomach ; she had a stool
daily, but it was trifling; the urine was of a greenish
black colour, the skin burning hot, dry, the pulse
quick, tense, and rather hard ; the catamenia had
not appeared for three months; for this she could
not assign a reason. Dec. Graminis cum Pot. tarL
On the 26th (the fifth day of her illness), the
symptoms continued the same, the urine black-red,
turbid, with an abundant sediment, the colour of
chocolate. This sediment was nothing but coagu-
lated blood, which was vicariously secreted by the
kidneys, and seemed to supply the place of the
menses. She had no pain in making water. Rad.
Gram; Fruct. Tamarind, enucleat. aa f- De-
coct. Colat. adde Potass, tart. 5j. Syr. Rubi.
3SS.
On the 28th, she complained of increased head-
ache; moreover, she could not bear the light, from
the great sensibility of her eyes, the eructation was
constant. Ordered four leeches to the temples,
which were repeated at night, and a blister to the
neck; Test, praep. 5j. was added to the mixture.
On the 29th, a general improvement took place.
c: 52 ;]
the catamenia had made their appearance, and
from this time the dark coloured sediment in the
urine ceased. On account of the still remaining
headache, four cupping-glasses, with scarification,
were applied between the shoulders, and sina-
pisms applied to the calves of the legs, a diminu-
tion of it ensued, but it returned on the 3d of
July, accompanied with shooting pains in the ears,
for which four leeches w^ere applied behind them.
On the 4th the symptoms had notably diminished,
the head was more free, the tongue cleaner, the
taste natural, the urine deposited a mucous sedi-
ment, and had the natural straw coloured appear-
ance. Ordered Dec. Gramin. Pob tartrat.
5ij ; but as frequent loose stools followed, fifteen
grains of muriate of ammonia were substituted for
the tartrate of potash. On the 7th, general im-
provement; the appetite returned, and a natural
evacuation by stool took place ; she had ordered,
Dec. tarax. simp. On the 10th she took, in order
to stimulate the languid digestion,^ Summit. Cen-
taur. min. fi Inf. ferv. Col. 5' j- adde Sp. nitr.
dulc. 5j. On the 16th she returned cured to her
service.
FEBRIS BILIOSA EX PLEURITIS.
Clara Musil, eighteen years old, a maid-serv.ant,
became sick without any assignable cause. She
had alternate chills and heat, particularly towards
the evening ; she lost her appetite, could scarcely
move from weakness, and could not allay her
thirst. She w'as troubled with entire loss of sleep
and had headache ; in the morning her mouth was
quite dry, and the tongue slimy. On the sixth
day of her illness, the 26th of July, she came into
the hospital ; the face was flushed and bloated,
c 53 :i
the skin, as well as the conjunctiva, somewhat
tinged with yellow ; she had ringing in the ears,
the tongue was covered with a thick yellow coat,
the taste bitter; on a deep inspiration she felt a
darting pain under the sternum, had a dry cough,
the urine was of a deep red, the skin uncomfort-
ably hot, and dry to the touch, the pulse very
frequent, small and oppressed. Ordered Dec.
Alth. cum ammonias muriat. et Syr. Alth. Emol-
lient fomentations to the breast. Dec. hordei
comp, pro potu. On the 37th the local affection in
the chest was increased ; six leeches, and, as the
bowels had not acted. Rad. Gram. 5j- Tamarind
fr. 5ss. fr. Decoct. Colat. 5'hj' adde Pot. supertart.
Sacchar. purif. aa 5ij. On the ^8th she had nau-
sea and eructation, and then soon followed vomit-
ing of a considerable quantity of greenish-yellow
phlegm; her state was something better. The
head remained notwithstanding very much affect-
ed, the ringing in the ears returned, the eyes were
dim, and as if covered with a veil or gauze, the
tongue dry, the stools scanty and hai’d, the skin of
a burning heat, no ways inclined to perspire, the
affection of the chest was less, the sub-nervous
state with excessive irritation of the vascular sys-
tem, and mischief in the liver was too evident to
be mistaken. Sinapisms were applied to the
calves of the legs, and glysters ordered ; the other
remedies to be continued. Her condition changed
slowly for the better. The head became more
free, the countenance less flushed, the tongue
threw off its coat, became moist, the thirst was
less urgent, the evacuations were daily more plen-
tiful, the pulse became slower and more ffee; her
countenance more lively, the urine was no longer
so high coloured, but the skin remained dry and
c 54 :]
rough ; to promote the obstructed perspiration,
Liquor. Auimon. acetat. was given ex Dec. Gra-
minis cum Sacch. this was soon followed by a mild
diaphoresis, and the skin became soft. But the
patient began now to spit very much, and a con-
firmed ptyalism came on without the least mercu-
rial having been given ; the gums bled easily, and
were spongy. Ordered, B Inf. Rad. Caryophyllat.
ex. 5ij. parat. 5'^hj. Sacch. alb. 5ij. also Inf. Salvise,
as a wash for the mouth. It was the 14th of
August, (the twenty-first day of her illnes.s), and
now for the first time the urine separated, and
threw down a bi'anny sediment ; her condition was
quickly changed for the better, for as yet that
change had been very slow, her appetite and
strength returned, and she left the hospital on the
20th of August.
FEBRIS PITUITOS.\.
Fevers of this type happened less frequently,
and always shewed a slow and tedious course ;
with regard to their treatment, the attending
faintness and apparent debility deterred one fi’om
a stimulating mode of practice, and yet on the
other hand forbade, by the too long continued use
of evacuating remedies, reducing still more the
patient’s strength ; the chief remedies in such
fevers are Potass, sulph; AmmoniEe murias; Antim.
tart, in small doses. Ipecac. Rhubarb and especially
flowers of arnica, afterwards senega, bitter and
tonic remedies. Should there be at first an indi-
cation for emetics, they produce the greatest be-
nefit, yet for the most part, some preparatory
course is necessary.
i: 55 3
John Schroder, a locksmith’s journeyman,
twenty-three years old, of a moderately strong
habit of body, lost, without a known cause, his ap-
petite, had a stupifying headache, principally in
the forehead ; felt himself w'eak and depressed,
had frequent shivering, after which an inclination
to vomit ; a week passed thus, w'hen on the 8th ot
February he came into the hospital. The head-
ache continued, the countenance was pale, the
look melancholy ; the tongue covered with a dirty
white tough slime, the appetite quite gone, the de-
glutition somewhat impeded, the uvula relaxed,
the thoi*ax free, the bowels loose, having a daily
evacuation, the urine pale red, the pulse mode-
rately frequent and soft. Dec. Tarax. cum Ammon,
mur. and an emollient gargle ofinfus. Flor. Samb.
et Malvae.Fol. cum Mell. Ros. On the 12th he had
many thin loose stools, and the strength diminished
remarkably. He took Infus. Rad. araicfe cum Am-
moniae mur. gr. xv ; and as the affection of the head
continued, sinapisms were applied to the calves of
the legs; the diarrhoea and the general state of
the patient became worse ; there was blood in the
stools, and he was sometimes near fainting ; the
abdomen was tense. R. Rad. arnicae 5ij. f. Inf.
ferv. Col. ^viij. adde Mucilag. acac. Syr. papav. ai
3ss. R. Pulv. Rad. Ipecac, gr. ij. Sacch. alb. 5j. f.
pulv. divide in doses vj. Sumat unum tertifi quique
horA.
On the Hth, the affection of the throat w'as still
the same, he also complained of oppression at the
chest, the diarrhoea had diminished, and no more
blood came away : ordered four cupping-glasses,
with scarification, to the sternum, and a blister to
the neck. R. Rad. arnic. Stipit dulcamar. aa 3ij.
C 56 3
f. Inf. fervid. Colat. adde Oxym- simp. 5ss.
Feb. 16th. The deglutition is easier; there is still
oppression of the chest; three more cupping-
glasses were applied to it ; he was better ; there
was a copious perspiration ; the appetite returned,
the pulse was freer, and the tongue clean.
On the 2d of March he complained of want of
sleep, headache, nausea, and loss of appetite, and
the tongue became white. He acknowledged that
he had eaten too much, having been allowed meat.
Inf. arnic. cum Ammoniae muriat. was given ; and
after he had used this some days, he took the fol-
lowing: K:. Inf. Sem- Faenic. ex 5ij- parat.
Tine. Rhei aquos 5ss ; and afterwards. Inf. Rad.
Caryophyllat. He did not, however, recover his
strength; the head was still affected, and all ap-
petite lost ; the tongue white, the pulse weak-
R. Flor. arnic. 5ij. Inf. ferv. adde Syr. alth.
3ss. To this was afterwards added Ext. card, be-
nedict. a blister w'as applied ; and after this. Inf.
Cal. arom. cum Sp. nitr. dulc. It required a long
time before the functions were restored to their
natural state. Nature, in this case, seemed to
conduce nothing; and except an occasional dia-
phoresis, no critical symptoms were noticed. It
was not till the 2ith of March that he was cured,
and left the hospital.
NERVOUS FEVERS.
There were five cases of fever admitted, in
which the nervous type was already established,
yet this accompanied a greater number of other
diseases ; gastric as well as inflammatory affec-
tions often passed into the nervous state, and
caused such complications, as were always much
c 57 ;]
more difficult to cure, and the treatment required
was often at variance with the preceding symp-
toms. For example, it often happened that the
fever had put on the nervous type, whilst the local
affection still required an antiphlogistic treatment;
nay, even genuine nervous fevers sometimes had
such violent exacerbations, that during the pa-
roxysm it was necessary to discontinue even the
mildest restoratives, and resort to refrigerants or
sedatives. He who does not keep his eye fixed
on this real contest between the vascular and ner-
vous systems, who, without making allowance,
uses only stimulants in nervous fevers, will doubt-
less do mischief ; he disturbs the efforts of nature,
which endeavours on many occasions to relieve
herself. It is then that the physician should be
only a prudent observer ; should remove obstacles,
and guide the disease in its course, but not pervert
it; above all, we must consider whether or not an
inflammatory state of the brain, or an insidious
inflammation of the intestines may not modify the
case- There is, for example, an insidious and ob-
scure inflammation of the intestines, which very
often attends the nervous and putrid type of fevers;
and as these patients commonly lie overcome with
stupor and delirium, it is difficult to make it out;
and it is only by a rough handling of the belly,
particularly in the hypogastric region, that the
patient will sometimes give signs of pain by groan-
ing, or contracting the muscles of the face. Dis-
tention of the belly and frequent purging, are usu-
ally present. Should the abdomen be very tense,
the examination of it will unfortunately afford us
no information ; very seldom, and only when the
inflammation reaches the upper part of the small
C 58 ]
intestines, have we that otherwise weighty and de-
cisive symptom of vomiting.
In the opening of the bodies of those who have
died of nervous fevers, we often find on examining
the abdomen, that the omentum and entire sur-
face of the intestines, are in a natural state ; but
by carefully untwisting the intestinal tube, there
appears commonly in the small intestines, some-
times even in some parts of the jejunum, but espe-
cially in the ileum, where it lies in the basin of the
pelvis near to the spine, dark red, inflamed spots,
which become more frequent as you proceed, and
at last a general inflammation of the ileum, for the
most part near to the ccecum, and this sometimes
for a space of several feet: the outer coats of the
intestines is usually deep red, and inclining to
black, and has on its surface often large spots of
a membranous putrid matter ; and when cut
through, the mucous membrane appears sometimes
moderately red, but often also quite dark red, and
full of ulcers, which exude a bloody ichor; this is
the insidious inflammation of the intestines, so
called with reason, as its seat is deep in the pelvis,
and hence is with difficulty discerned. With the
true spirit of observation, Ludwig, in his Institutes
of Clinical Medicine, (Lips. 1758. p. 155.) calls our
attention to this inflammation, when he says,
“ that the examination of the bodies of those who
have died of malignant and exanthematous fevers,
almost always presents some part of the intestines
inflamed, and this without any material pains hav-
ing preceded.” Let us, however, beware not to
infer from these observations, that nervous fevers
in general consist in an obscure inflammation of
the intestinal tube; for certainly, in the greater
number of them, the belly is free from pain, there
c: 59 ;]
is no distention, the stools are either natural, or
the diarrhoea is moderate, and the disease termi-
nates favourably and critically, with gently stimu-
lating remedies, which could not be the case if
such a baneful inflammation was present in all of
them. Moreover, many who die of nervous fever,
and are opened, do not shew any morbid alteration
of the intestines.
If we consider this in a practical point of view,
we shall find that nervous fevers in general are
but the termination of previous inflammatory or
gastric fevers ; should the gastric character of the
fever be overlooked, should it be left to itself,
treated too roughly, or with heating medicines,
the already existing irritation of the intestines is
easily urged to inflammation, which has time, from
the protracted course of the disease, to form itself
by little and little, and hence, does not make its
appearance with sudden violence, but in an insi-
dious manner ; and from the sympathy existing
between the intestinal tube and the brain, the
functions of that organ are deranged. But why
the ileum should especially become the seat of
this lurking inflammation is not yet explained by
the known laws of physiology or pathology ; fur-
ther remarks on this subject are to be found
in my work on the Principles of Practical Me-
dicine, in that part which relates to the treat-
ment of nervous fevers. One can scarcely doubt
that an oppressed sthenic state, and no real want
of power is at the bottom in nervous fever, not-
withstanding the appearances taken together
are nervous ; nor can any one object but that
there may be equally an oppressed state of the
nervous, as well as of the vascular system. The
expressions nervous state and weakness are hence
[ 60 :i
any thing but synoninious ; there is a nerv’ous
state, with sufficient, and also witli oppressed
energy ; so on the contrary, a great degree of real
debility may exist without any nervous symptoms
being present. Experience teaches, that when,
by a practice more observant than active, nervous
fevers are brought to the period of a regular
crisis, this passed, the powers of life develop them-
selves again spontaneously. He who in that case
gives stimulating remedies will increase the deli-
rium, or even bring on inflammation of the brain,
and if, deceived by the sinking strength, he pur-
sues that course, the patient will die apoplectic,
or exhausted from excessive irritation. There is
seldom any real want of strength in the beginning
of nervous fever ; nature makes every effort to
overcome the stimulus of the disease ; the pulse
is any thing but weak ; it does not indeed manifest
such resistance as in inflammatory fevers; but it
resists sufficiently the Anger applied to it ; and
becomes, during the exacerbation, often turbulent
and somewhat hard. Perhaps it may depend on the
prevailing inflammatory character of diseases in
our time, that nervous fevers do not bear the ver}'
stimulating treatment which we find was employed
so generally by physicians at the beginning of the
present century. Hence salep *, muriate of am-
monia, and blisters, often suffice to bring about
a favourable issue to the disease ; but on other
occasions, mild stimulants, such as Caryophyllata,
and Rad. arnica? are required ; it is only in a more
depressed state of the powers of life, and when
there is no hardness of the pulse, that Camphor,
Angelica, Valerian, Liq. Ammon, subc. and jEther,
&c. are necessary.
• 'I'lie dried root of the Orchis, morio et iiiascula.
n 61 n
The following are cases of this year : —
FEBRIS NERVOSA.
A servant-maid, twenty-two years old, of middle
stature, overstrained herself with too hard work,
and fell sick. Some affection of the head, shiver-
ing, and subsequent heat, were the symptoms
which first appeared : ten days passed over with-
out her having recourse to any remedy ; and on
the 20th of February, she applied for relief at the
general hospital. Vertigo, headache, ringing in
the ears, and partial deafness, a pale countenance,
and wearied aspect, a dry tongue, tense abdomen,
high-coloured ui’ine, costiveness, dry and hot skin,
a quick though sufficiently strong pulse, were the
prominent symptoms. Decoct, Rad.Gramin. ^viij.
Sodas sulph. jij. As on the following day, a gentle
evacuation had taken place, 15 grains of muriate
of ammonia were ordered, instead of the Glauber’s
salt, and a blister was put between the shoulders.
For some days she continued in the same state,
yet the tongue became cleaner and was moist.
She now had Infus. Rad. Caryophyllat, but as the
pulse was more depressed, and the skin remained
dry, two grains of camphor were added to the in-
fusion ; it proceeded as a moderate nervous fever ;
the vertigo and deafness became less, though no
crisis appeared ; but on the 28th, a cough came
on, and she complained of soreness of the throat
and hoarseness ; for this a linctus and decoction
of Salep pro Potu were ordered. The cough con-
tinued, and was no less on the 3d of March ; and
there appeared streaks of blood in the expectora-
tion, the consequence of her straining with the
cough, for there was neither pain of the chest nor
impeded respiration ; she was in a vei’y low state,
G
[; 62 j
and the pulse weak. Instead of the camphor, 55s.
of Liq. Ammon, succinat. was added to her mix-
ture ; still the cough increased in violence, and it
was most troublesome to her at night.
It was now necessary, notwithstanding her loss
of strength, to substitute a decidedly emollient
practice ; and she took Dec. R. Alth. cum Inf.
flor. Papav. Rhsead. and Syr. Alth. and had a
blister applied to the sternum, ^^'ith the conti-
nued use of these simple emollient remedies, the
cough became less and disappeared ; the sleep was
undisturbed, a moderate perspiration, and gradu-
ally a critical mucous sediment in the urine ap-
peared ; the appetite returned ; and by a restora-
tive diet the patient so recovered, that on the oth
April (the fifty-fourth day of her illness) she re-
turned cured to her place.
FEBRIS NERVOSA CUM MILIARIBUS RUBRIS EX ALBIS.
The miliary fever belongs to the exanthemata,
which even now, as to their nature, are attended
with much obscurity and uncertainty. During the
last century, many physicians wrote on dreadful
miliary epidemics, whilst some regarded this erup-
tion as a symptom of no moment ; nay, even as the
mere consequence of neglected cleansing of the
primas vias, or of the too heating regimen then ob-
served in fevers. It is, doubtless, true that it may
be artificially pi’oduced by the above circum-
stances, especially by the employment of unduly
stimulating remedies ; but without these, in certain
years it appears as a symptom in many diseases;
I am even persuaded that there exists a distinct
idiopathic miliary eruption ; and I had several
very difficult and dangerous cases of it under my
care in the years 1814 and 1815.
C 63 3
This idiopathic eruption manifests itself chiefly
by an nncertain acute course of the fever ; there
is a very quick, excited and tense pulse, which on
uncertain days, seldom from the 4th to- the 7th,
more frequently on the 11th, 14th, or 17th, is ac-
companied with an indescribable anxiety, a tight-
ness and contraction at the left side of the thorax,
irregular respiration, with frequent sighing, a very
peculiarly hard sounding cough, and frequently
an irregular intermittent pulse : the pathognomo-
nic signs of pleurisy or peripneumony are wanting,
and one is at a loss satisfactorily to account for
the appearance of these symptoms. It is now that
either the red or white eruption breaks out in an
irregular manner’, and with copious perspiration ;
it often suddenly disappears, and at an uncertain
period a fresh eruption takes place. Should the
violence of the fever apparently diminish after the
eruption, and the ])ulse become more calm, slow,
and soft, it is a favourable sign ; but should, as
unfortunately is too often the case, (even after a
copious and high-coloured eruption) the fever con-
tinue violent, and the pulse be very frequent and
hard, there is always great danger, and the disease
often in a few hours terminates in death. In such
a case I found, on examination, the pericardium
inflamed.
The symptomatic miliary eruption which takes
place, more particularly in puerperal, nervous, and
putrid fevers ; and sometimes in genuine inflam-
matory and bilious ones, is of great consequence ;
for if, after its appearance, the symptoms of the
disease are not materially improved, it is always of
serious import. It is seldom absolutely critical
(except in inflammatory gout), and it is only of no
consequence when it appears, after other effectual
n 64 ]
and salutary critical symptoms, or where there is
no accompanying fever. Whether the idiopathic
miliary fever, which is epidemic in some years, is
also contagious, I cannot from experience deter-
mine. The following is a remarkable and danger-
ous case of nervous fever, in which this eruption
bore an essential part : —
Anna Bohm, twenty years old, a chamber-maid,
travelled with her master’s family from Vienna to
Prague, and ate during the journey little else than
fruit and vegetables. She brought on a confirmed
diarrhoea, to which, during ten days, she paid no
attention, till at length blood was passed, and she
was extremely reduced. A physician ordered some
medicine not specified, which immediately stopped
the purging ; but violent headache, ringing in the
ears, great thirst and heat of the body came on,
which induced her to apply, on the 20th of July,
to the general hospital. Her countenance was
flushed, the tongue white, and the taste bitter,
she desired acid drinks, the chest and abdomen
were free from pain, there had been no stool for
three days, the urine was high-coloured, the pulse
quick, full, and tolerably strong. Ordered, Dec.
Gramin. 5b • Puhi jss.
On the following day, the red miliary eruption
shewed itself on her breast and arms ; she had
three stools of a soft consistence. In order to
avoid bringing on again the diarrhoea, Ammonije
muriat. gr. xv. were added to the decoction in-
stead of the soluble tartar. She went on till the
26th, when the eruption began to disappear, with-
out evident marks of crisis : indeed she was much
more restless, wandered, and fell into a state of
insensibility ; spontaneous evacuation by stool,
trembling, deafness, a dry hot skin, and great de-
C 65 3
pression of the pulse, excited our alarm as to her
safety. Flor. Arnicas 5ij. f. Inf. ferv. Col.
acide Camphor, subact. gr. ij. Muc. Acaciae ^ss.
As her strength still diminished, and subsultus,
with picking of the bed-clothes came on, the dose
of camphor was increased. Ammon. Subcarb.
and Castor- ai gr. ij. were given together in pow-
der; also Liq. ammon. succinat. 5j- added to
the Infusion. Blisters and sinapisms were repeat-
edly applied. Notwithstanding the diligent em-
ployment of these restorative means, she fell into
a state of the greatest possible debility ; there was
strabismus and the hippocratic countenance, the
pulse was extremely quick, and from its weakness
scarcely, and only with great attention, to be felt,
which, with coldness of the extremities and the
constantly dry skin, made us, during four days,
consider the patient in a dying state.
The only means left, so far as regarded the
suppressed eruption which appeared to be the
cause of these bad symptoms, was the use of luke-
warm aromatic baths, to each of which a solution
of half an ounce of Potassa fusa was added, and
the skin afterwards rubbed ; the most surprizing
and powerful effect was produced by the employ-
ment of them ; the patient w^as more quiet, per-
spired, and slept several hours after the first bath ;
after the third, the eruption broke out on the
whole surface, but in its white form. After some
days of the greatest danger, the urine became
turbid, and threw down a thick mucous sediment.
It was now the twenty-first day of the disease;
her state became evidently fetter, the delirium
went ofi’; her consciousness returned, she felt re-
newed strength, got sleep, the pulse rose and was
more free, but the ringing in the ears lasted long,
C 66 3
and ceased only by degrees. In the state of con-
valescence, bitters, with Spt. JEth, nit. et Sulph.
compos, were employed to aid the digestion, and
a moderate portion of wine was allowed. As she
was young her strength soon returned ; and freed
from her sufferings, she in six weeks enjoyed per-
fect health.
PLEURITIS NERVOSA ET ENTERITIS OCCULTA.
Anna Tichowskin, twenty years old, a maid-ser-
vant, of a stout make, had for about three months,
without any assignable cause, ceased to mens-
truate, and suffered during that period various
affections of the chest, headaches, and wandering
pains in the abdomen and the lower extremities.
Notwithstanding which, she went about her busi-
ness without using any remedies.
On the 27th of March, she brought on a pleu-
risy by raising some heavy weights. It was on the
sixth day of her illness that a physician ordered
her to be bled, and to take Decoct. Altluese nitros.
On the 3d of April, eighth day, she came into
the hospital with symptoms of a violent pleurisy,
attended with purging; eight ounces of blood
were immediately drawn, fomentations applied,
and emollient remedies used. She became better,
the local pain was much lessened, but the fever
put on the nervous type, favoured no doubt by
the violent diarrhoea which preceded. Powders,
witli one-third of a grain of Ipecacuanha, a thick
decoction of salep, and frequent mucilaginous
glysters were employed. The diarrhoea was more
moderate, but did not cease; the fever became
more violent, there came on distention of the ab-
domen, ringing in the ears, wandering, partial,
and lastly, complete deafness; the tongue and
C 67 3
lips were dry, and covered wdth a brown coat, her
strength sunk more and more, the pulse was very
quick, small, and weak ; a little camphor was
added to the salep decoction, and nutmeg to the
ipecacuan powders ; soon after, these were changed
for Inf. Rad. Arnicae cum Liq. Ammon, subcarb,
and Mucilag. Acaciae, fomentations and blisters ;
later. Inf. Rad. Arnicae, et Cascarill. with Cam-
phor, were brought into use ; but nature seemed
hastening towards dissolution, and not to be stop-
ped in her course ; she lost her sight, and her stools
were voided involuntarily, the pulse was scarcely
perceptible, and thready. Decoct. Cort. Chin, with
Camphor, after with Tinct. Opii. and powders with
musk, aromatic frictions and baths were of no
avail in prolonging her transient existence. On
the 4th of May, after thirty-one days of fruitless
treatment, death put an end to her sufferings.
Examination after Death. — On opening the
cranium, there was found between the dura
and pia mater, in several places, extravasation of
clear lymph. The ventricles were in their natural
state, the right lung was firmly adhering at its
posterior half with the pleura, and covered with
exudation. The left lung was sound and free;
only at the upper point it was distended and
hanging to the pleura costalis ; the pericai’dium
contained the usual quantity of fluid. In the
right ventricle there was a very large coagulum,
which filled half of the cavity, and extended a
considerable way into the pulmonary artery. The
liver was found shrivelled, the gall-bladder half
full, the stomach and the whole intestinal tube was
so full of air, that the omentum, instead of cover-
ing the intestines, was dislodged entirely under the
c: 68 ;]
diaphragm. The descending portion of the colon
was for twelve inches contracted to one-third of
its bore, had become thick with a pseudo-mem-
hranous coat towards the flank, was in a state of
chronic inflammation, and surrounded with a
quantity of sanious lymph.
When one considers maturely this case, it will
appear that the entire disease was the consequence
of a continued, and for a long time neglected in-
flammatory affection: the disappearance of the
menses, the two months headache, the affection
in the chest, and especially the shooting pains in
the abdomen, were produced by an insidious
chronic inflammation.
A mechanical cause gave rise to the pleurisy ;
the first bleeding was employed, and the patient
only then, viz. on the eighth day of her complaint,
was brought into the hospital ; here the bleeding,
so indicated by the inflammatory symptoms, was
repeated, and she seemed better, but now the
nervous state in a high degree came on. This was
evidently a consequence of the violent diarrhoea,
which itself was produced by a chronic inflamma-
tion, already causing eftusion ; and by a contrac-
tion of the descending colon, of which from the
absence of pain no certain diagnosis could be
formed ; and in the more advanced state, the con-
tinued delirium, deafness, and excessive distention
of the abdomen, occasioned lier to shew no signs
of pain on examination of it, not even by contrac-
tion of the facial muscles.
The practical inference to be drawn from tliis
examination, proves of wliat consequence in ner-
vous fevers it is, to ascertain the state of the ab-
dominal viscera ; and how often insidious and
occult inflammation of the viscera, particularly of
C 69 ]
the ileum, is connected with them. In this case,
truly, the effusion and organic mischief about the
colon would have rendered any other treatment
equally inefficacious.
Another case of nervous fever, accompanied
with intestinal inflammation, occurred this season.
It is of too much importance not to be particu-
larized— it began also with pleuritic inflammation.
FEBRIS NERVOSA CUM ENTERITIDE, ORTA EX
PLEURITIDE.
A delicate young woman, thirteen years old,
took cold from washing linen, and soon felt chills
with subsequent heat and lassitude, headache,
thirst, and pain in the chest. On the fourth day,
the 11th of June, she came into the clinical hos-
pital with headache, circumscribed flushed cheeks,
and the rest of her countenance pale ; hurried res-
piration, pungent pain of the left side on a deep
inspiration ; a frequent, full, and hard pulse. She
had six leeches applied to the part, emollient fo-
mentations, and Potass, nit. ex Dec. Alth.
On the fifth day the pain was much lessened.
On the sixth, the tongue was dry, and coated with
a brown fur ; her countenance became a dead
white, and was sunk and drawn into a longer
shape, the eye dull, the head stupified ; ringing in
the ears and difficulty of hearing took place ; there
was a red spotted eruption on the breast and
arms, which disappeared on the following day; the
pulse remained somewhat hard, in the night there
was a continued muttering delirium. As the head
was so much affected, and regarding also the
very weak state of the patient, two leeches were
applied behind the ears, and on the temples, then
repeated sinapisms and blisters ; instead of the
c; 70 3
nitre, 12 grains of muriate of ammonia were
added to the mixture. When about the twelfth
day, she was awaked out of her extreme heaviness
by questions ; she began to complain of pains in
the abdomen, the hitherto unaffected belly was
tense, and could not bear touching, any attempt
at which caused contractions of the facial muscles,
the stools were regular, the pulse quick, full and
tense, without being absolutely hard. To coun-
teract this threatening symptom, there were ap-
plied to the epigastric region, notwithstanding the
paleness of the countenance, the confirmed coma,
and increased debility, four large leeches, emol-
lient fomentations, and internally the Inf. Lin. cum
Mucilag. Acaciae et Saccharo. On the thirteenth
day, as the pains continued, the leeches were re-
newed ; now the belly subsided, became soft and
free from pain; the pulse too was no longer so
tense, but became softer. On the fifteenth day,
to obviate the sinking pulse, and to support the
strength, Infus. Caryophyllatse, with muriate of
Ammonia was given ; and for the tendency to
diarrhoea, powders with one-third of a grain of
ipecacuan ; and for the still troublesome head-
ache, a blister was applied to the neck. On the
following day, the patient was a good deal relieved
by perspiration which had taken place ; and the
urine, which till now had been high-coloured,
threw down a sediment, which continued many
days.
From this time no remarkable accident occurred,
the countenance was indeed so sunk, that the pa-
tient appeared in a very hopeless state, yet the
respiration, as well as the pulse was regular, the
stupor went off, and the appetite returned. A nou-
rishing diet, the use of bitters, as the Inf. Caryo-
c: 71 n
phyllat. cum Ext. Centaur, min ; and at last, Dec.
Cinchon. cum Calam. Aromat. and Sp. ^Eth. nit.
forwarded remarkably her recovery ; and within a
month she was discharged quite cured.
PUTRID FEVER.
9
There were two putrid fevers treated, both of
them the consequence of previous gastric fever,
which had been entirely neglected; they were at-
tended with a broken crasis of the blood and vio-
lent diarrhoea ; they were admitted when the
disease was fully formed : their treatment will ap-
pear from the following statement : —
FEBRIS PUTRIDA GRAVIOR.
Johann Czermak, a student, nineteen years
old, without evident cause, became ill of a gastric
fever, on the 1st of February, 1823, refused every
assistance, and came in a wretched condition, on
the 22d of the same month, into the hospital.
General depression and loss of strength, so that
he could not sit up, his countenance sunk, pale,
and peculiarly disturbed, sunk eyes, stupid looks,
tinnitus, vertigo, a dry brown coat on the tongue,
teeth and lips. Trembling of the limbs, the belly-
drawn up, painful on pressure, frequent and very
foetid stools, a dry skin with burning heat, the
pulse frequent, soft, and weak, presented them-
selves as the characteristic symptoms of the be-
fore-named disease : there was ordered, R. Kad.
Arnicae 5ij. ft. Inf. fervid; Colat. ,^viij. adde Ext.
Calumb. 5ij. Mucilag. Acac. Syr. Papav. aa ^ss.
R Ipecac, contr. gr. iij. Sacch. pur. 5j. div, in
dos. vj. sumat. unam secundi qu&que hor&.
Glysters made with an infusion of rue" and cha-
momile with starch. Sinapisms to the legs, and
c: 72 ;]
emollient fomentations to the belly- As towards
evening a smart exacerbation with a determina-
tion towards the head, came on, the countenance
became flushed, and he wandered ; four leeches
were applied to the temples ; when they fell off,
he lay exhausted and without consciousness. Si-
napisms were applied to the upper part of the
thighs, and a blister to the neck, the medicine
continued. On the 24th, the exhaustion was ex-
treme, the belly distended in an uncommon de-
gree, and painful, the stools voided spontaneously.
Three leeches were applied about the navel, from
a well grounded suspicion of concealed intestinal
inflammation, the poultices which were trouble-
some from their weight were exchanged for fomen-
tations. After the leeches he felt some relief, so
that as there was still pain, two more were ap-
plied to the belly, and powders with ipecacuan in
divided doses with nutmeg ordered. On the
27th, the improvement was remarkable, the cir-
cumference of the belly less ; he bore the hand-
ling of it tolerably well ; the stools were dimi-
nished. On the 1st of March, the urine had
marks of crisis, the evening paroxysms were more
moderate, and he became stronger. On the 3d,
the diarrhoea returned, the belly was without pain;
ordered, R R. Arnicje 5iij. ft. Inf. ferv. Jidd.
Ext- Tormentillae 3j ; Mucilag. Acac ; Syr. Papav.
aa 5ss. The ipecacuanha powders were conti-
nued, the purging soon gave way, the skin be-
came soft ; perspirations followed ; the urine for
some days threw down a sediment, and the pa-
tient’s look mended; thus his recovery went on
slowly but uninterruptedly. On the 14th of
March, the fifty-second day of his illness, he left
the establishment cured-
C 73 ]
This difficult case required throughout, the
most strict attention to the state of the intestines.
FEVERS WITH PREVALENT LOCAL AFFECTION.
Topical Inflammations-
Inflammations of particular organs were fre-
quent this year, and each month had some ex-
amples of them. The forms were various under
which they appeared, yet those of the chest were
most prevalent, particularly of the pleura and lungs ;
of the abdominal cases, hepatitis and peritonitis,
were the most common. The antiphlogistic treat-
ment was always adopted; sometimes the more
energetic one of venesection, at others the milder,
which consisted of emollient, cooling, attenuating
remedies. The treatment must always be accom-
modated to the violence of the general and local
affection, and to the importance of the affected
organ.
INFLAMMATIONS OF THE BRAIN.
Encephalitis Phrenetica.
A woman, thirty- six years old, after great bo-
dily exertion, was affected with headaches, and
soon after fell into wandering and insensibility ; in
this state, and on the third ^y of her illness, she
was brought into the hospital. A peculiar laugh-
ing gay look, the face hot but not flushed, rolling
eyes, continued prattling, with a busy motion of
the limbs, characterized her state ; the pulse was
very quick and contracted, though from the con-
tinual motion of her hands, this could scarcely be
accurately determined. As sbe would not remain
in her bed, it was necessary to put on the strait
jaeket. She was bled to eight ounces : cold appli-
u
C 74 ;]
cations to the head, a mixture with Dec. Graminis
et Sodae Sulph. and a powder with a grain cf
calomel, given every two hours, procured, within
five hours, quietness, and in three more brought
the patient hack to her consciousness and reason.
On the following day, as she still complained of
headache, and the head was hot to the touch, six
leeches were applied to the temples, the wounds
bled freely, and these symptoms disappeared. She
had some loose stools, and a sediment appeared
in the urine; the calomel was omitted, and her
mixture not given so frequently : by its continued
use she was cured within three days, and in a
week left the hospital.
INFLAMMATIONS OF THE THROAT.
This sort of inflammation is not unfrequent; in-
flammations of the tonsils, of the velum pendulum,
and uvula, are often numerous. The most com-
mon causes are exposure to cold when the body is
heated, and the sudden use of cold drinks ; a moist
atmosphere also materially predisposes the body
to such affections. Those were most easily affected
who had frequently before suffered from it, and
had not avoided the occasional causes ; so also it
w'ent on to suppuration in those more readily, who
had often before experienced this termination of
the disease. The much more dangerous inflam-
mation of the trachea occurs less frequently, though
children are more liable to that peculiar form of
it, called the Angina membranacea, or Croup.
The treatment of these inflammations will appear
from the cases related, five of which were admit-
ted this year.
c 75 :]
ANGINA FAUCIUM.
A stout servant-maid, twenty-six years old, told
us that she had frequently had sore throat, and
that if she got the least cold, it was followed by a
difficulty in swallowing. On this occasion she had
caught cold from washing linen ; there was alter-
nate heat and cold, accompanied with great pain
in the throat. When taken into the hospital on
the 14th of February (the second day of her ill-
ness), it was only with the greatest pain and exer-
tion that she could swallow ; the velum pendulum,
uvula, and tonsils, were of a deep red colour, and
much swollen ; one might also from without feel
the tonsils enlarged ; the fever was rather violent,
the pulse frequent and compressed, without being
hard. Ordered four large leeches to the neck, an
emollient gargle of Decoct. Alth ; emollient fomen-
tations to the neck ; inwardly. Decoct. Althagse cum
Roob Sambuci. The leeches gave great relief.
The inflammation was by the diligent use of these
remedies subdued in four days. On the 20th of
February, the ninth day of her illness, she returned
to her service cured. Critical sweats, and sedi-
ment in the urine, took place on the 5th, 6th, and
7th days.
Second Case. — Josepha Cadet, a maid-servant,
twenty-five years old, of a delicate habit, brought
on Angina, by exposure to cold on the 26th of
May. On her admission the day following, be-
sides the symptoms of a moderate inflammatory
fever, she had the following : she could not speak
loud, was hoarse, and could only swallow liquids
with great pain ; the respiration was not absolutely
impeded, but accompanied with a hissing noise.
On examining the throat, the tonsils were fouml
C 76 ;]
swollen, inflamed, and covered with whitish yel-
low spots, which were only accumulated mucus,
but which had the deceptive appearance of puru-
lent patches ; the arch of the palate, the uvula, and
the posterior parietes of the gullet, were red and
inflamed ; six leeches w'ere applied to the neck,
emollient fomentations and lukewarm gargles used,
and inwardly, Emulsio gummosa. As on the 28th
of May, the above symptoms continued equally
violent, and moreover an oppressive pain in the
course of the trachea was added; four leeches
were repeated, and a grain of calomel given every
three hours; a blister applied to the breast, and
as the bowels had not acted, a glyster with salt
was prescribed. On the 30th, the inflammatory
symptoms of the throat and the chest were much
diminished; the deglutition and breathing unim-
peded ; but now an oppressive pain was felt in the
region of the stomach. Decoct. Althseae mannat.
was ordered. On the 1st of June, the pain at the
stomach continued w’ith periodical attacks. Oxyd.
Zinci was now given, half a grain every three hours
with sugar ; the pains ceased on the following day,
and on the 4th of June, she was able to return to
her service cured.
LARYNGITIS.
John Schanda, thirteen years old, a printer’s
apprentice, of a weak habit of body, suflered al-
most yearly from his childhood with sore throat; he
had been, during a fortnight, treated at home with
medicines, which w'ere not specified ; and on the
8th of March was admitted into the hospital. His
countenance w^as pale, moderately warm ; his voice
harsh and piping; he complained of a pungent
pain in the larynx, which was increased by hand-
c: 77 :]
ling the part ; there was nothing inflammatory to
be seen in the throat; he had frequent returns of
a harsh, hard cough, which increased the pain,
and was attended with contraction of the facial
muscles ; his swallowing was affected, and the res-
piration hurried ; the fever, however, was mode-
rate. Four leeches were ordered to the larynx;
emolUent vapours to be inhaled through a funnel,
and fomentations to be applied to the neck ; in-
w’ardly, Dec. Alth. cum Pot. nitr. et Syr. Alth ;
as the inflammatory symptoms were not much les-
sened, they were overcome by repeated applica-
tion of the leeches. The cougli became more
free, the fever moderate, the expectoration was
yet difficult; Sulph. sublim. gr.j. every three hours
was given. After some days use of these remedies
the cough was milder, the expectoration abundant,
it came away in puriform globules, now and then
marked wdth a streak of blood, the pain entirely
ceased; there was an abundant general perspira-
tion, and urine with sediment ; all morbid symp-
toms disappeared ; and on the 22d of May, he
went home in perfect health.
ANGINA LARYNGEA ET PHARYNGEA.
John Janish, a journeyman, forty-five years old,
much addicted to liquor, had, when drunk, a scuf-
fle in the street, in which he was roughly handled,
and at the same time he must have caught a bad
cold, as at this time the weather was very severe.
After he came to himself, he felt pains in his
throat, which impeded his deglutition ; he paid no
attention to this, and several days elapsed before
the 18th of March, when he was admitted into
the hospital. He complained on admission of his
head being affected, his look was troubled, the
H 3
colour of his Qountenance had a peculiar yellow
cast, his thirst excessive, his deglutition very diffi-
cult, there was nothing but a slight redness to be
seen in the throat; but on examination of the neck,
he complained of pain about the larynx, and in the
course of the oesophagus ; he coughed incessantly,
with the sound peculiar to inflamed trachea ; he
had no pain in the chest, the pulse was very fre-
quent, oppressed, and rather hard ; there was no
trace of his having received any external injury.
He was ordered to be bled to six ounces, a poul-
tice of bread and milk to the neck, and to take
Decoct. Alth. mannatum. The blood assumed a
thick inflammatory coat ; the pulse, however, sank
and became weak, though the inflammatory symp-
toms continued, and his swallowing became more
difficult. Eight leeches were in consequence ap-
plied to the trachea, and powders with half a grain
of calomel, and one-third of a grain of ipecacuanha
(as his bowels were relaxed) ordered to be taken
every two hours.
On the following day, all the symptoms were
worse; he had been delirious the whole night, the
deglutition equally difiicult ; the calomel was in-
creased to a grain, and six leeches repeated ; to-
wards evening a sinapism was applied to the
throat, and Ungt. Hydrarg. fort, rubbed in on each
side of it. Still the nervous symptoms developed
themselves; the warmth of the body diminished,
the pulse w'as very frequent, low and thready, the
eyes distorted, and he lay motionless. Blisters,
camphor, and polygala senega were used in vain,
and he died on the fifth day after his admission.
Autopsia. In the cranium, nothing extraordi-
nary was observed, except some exuded lymph on
the surface of the brain. In the oesophagus, the
C 79 ;]
mucous membrane was very red, entirely covered
with exuded lymph, here and there blackish blue
spots, which were also found in the larynx, though
here they M'ere more red, and had the appearance
of bruises; the right lung was black, and its pleura
firmly attached to the ribs ; the small intestines
were very red.
INFLAMMATIO GLAKDULjE THYROIDE/E.
The following uncommon and interesting case
came on in the form of an inflammation of the
thyroid gland: — Anna John, twenty-four years of
age, a nurse, of a middling stature, weaned her
child on the 16th of December, 1822; two days
after, she had headache, heat and cold, with com-
plaints in the neck, for which she took some me-
cine at home.
On the 20th, she came into the hospital in the
following state : — She had pain at the back of the
head, her countenance was pale and sunk, her look
melancholy, her thirst increased, her voice weak,
deglutition impeded, but without traces of angina,
the tongue somewhat white. On the neck exter-
nally, the thyroid gland was enlarged, the skin
stretched, and painful to the least touch ; on a deep
inspiration she felt a darting pain in the fore part
of the breast, without any cough being excited ;
at the same time there was a constant inclination
to vomit, though she felt no pain from pressure
of the stomach ; the urine was rather high colour-
ed ; she had had two loose evacuations, the
warmth of the skin was moderately increased, the
pulse frequent, oppressed and small ; she felt her-
self, moreover, very much cast down.
The disease was as to its form considered to be
an inflammation of the thyroid gland, yet the
c 80 ]
troubled, pale countenance, the great debility, the
contrast in the symptoms, viz. the impeded deglu-
tition, without any inflammation or other mecha-
nical impediment, the almost extinguished weak
voice, the pains of the chest,without the other signs
of inflammation ; the constant inclination to vomit,
wdthout gastric impurities or pain at the stomach,
the circumstance of an oppressed small pulse,
seemed to warrant the conclusion, that it bore
rather the character of a nervous fever. But if
one considers the tenor of all the symptoms col-
lectively, and compares them with the physiolo-
gical destination of the organs, it will appear that
the pain in the occiput, the peculiar derangement
of the vocal organs, and of the deglutition, also of
the expectoration and stomach, announce a morbid
affection of the nerves supplying the neck, chest,
and abdomen as the cause; and from the deranged
functions of which, from inflammatory irritation,
all the symptoms are satisfactorily explained.
Hence, a rather antiphlogistic treatment was di-
rected against this inflammatory irritation ; six
leeches were applied to the thyroid gland, and
along the neck, emollient fomentations ; Decoct,
salep, and every three hours half a grain of calo-
mel was administered. In the evening, as the
tense pain of the gland continued, six more leeches
were applied, and mercurial ointment was rubbed
in on each side of it.
On the 21st, her state was, after a rather un-
quief night, much the same, only the constant in-
clination to vomit had diminished. A blister was
now applied to the nape of the neck. Towards the
evening the deglutition was easier, vomiting still
took place, by which a little phlegm was thrown
up ; for this, powders with four grains of magnesia.
[; 81 :]
as much sugar, ealomel and hyoscyamus, each half
a grain, were given every three hours.
On the 22d, the swallowing was still better, and
the vomiting had ceased by the use of the powders,
tjie swelling and pain of the thyroid gland were
considerably less; the patient had four loose stools,
the urine threw down a mucous sediment, the
pulse was still frequent, yet more free, and suffi-
ciently Strong-
Dec. 23d, all tlie symptoms are milder, the
gland is almost free from pain, but hard ; the pa-
tient has a cough ; the same on the 24th, though
at night a troublesome vomiting came on again,
and she suffered a good deal from the cough and
mucous expectoration ; she now took powders
with half a grain of hyoscyamus, Ung. Hydrarg. to
the region of the stomach, and a blister was ap-
plied to the sternum. On the following day she
experienced much relief; though on the 27th, the
gland seemed to be more swollen, tense and pain-
ful, the cough continued, though the breathing
was perfectly free ; four leeches to the gland, and
emollient applications were employed, she conti-
nued the salep decoction. In the days which fol-
lowed she improved, though, on the 30th, she felt
again severe pains in the gland, for which four
leeches were applied. Finally, by the diligent use
of emollient cataplasms, and inunction of mercurial
ointment, the inflammatory disposition of the part
was overcome, and it was restored to its natural
size; so that on the 4th of January, the patient
was quite well.
On that day, however, towards evening, with-
out any cause, she had a smart attack of fever,
with shivering and heat, which returned on the
following day at the same hour. We looked for
c: 82 ;]
an intermittent fever, and merely observed its
progress, but she had no return of it ; and on the
15th of January, she left the hospital cured.
INFLAMMATIONS OF THE THORAX.
Inflammations of the chest are divisible into
pleurisy, peripneumony, pleuroperipneumony, and
inflammation of the trachea and bronchia ; pleu-
risy is known by a continued pungent pain in the
side of the chest, which is increased by a deep
inspiration, and is attended with inflammatory fe-
ver, a dry cough, a full, hard, though also often
an oppressed pulse. In inflammation of the lungs
themselves, there is no positive pain, but a con-
tracted oppressive sensation, as if a great weight
was laid upon the chest, and a cough which is ex-
cited by a deep inspiration ; the respiration is la-
borious, and attended with a bloody expectoration.
The pleuroperipneumony is a combination of both
these affections.
Inflammation of the trachea is characterized by
a sensation of pressure and contraction under the
upper part of the sternum, peculiar anxiety, a dif-
ficult and often wheezing respiration, a very tor-
menting harsh sounding cough, which comes by
fits, or on an attempt at a deep inspiration, and by
the drawing in of cold air ; it is attended with
symptoms of suffocation, with strangulation and
convulsions. The expectoration is at first scanty
and streaked with blood, but later it becomes more
tenacious or thicker, is white, saffron coloured, or
cinder-grey.
It is generally held that these inflammations are
never entirely distinct from each other, and that
the symptoms of pleuritis are always connected
with those of peripneumonia, and the converse ;
C 83 ;]
and that generally, on examination, one finds all
the contents of the thorax inflamed. But this
assumption is contradicted by careful observa-
tion; for there are inflammations of the lungs, in
which, through their whole course, no trace of
pungent pain is present, and they are, no doubt,
distinct peripneumonies. It is otherwise with
pleurisy ; this not uncommonly begins in a distinct
manner as such ; the pungent pain and deficiency
of expectoration suflSciently characterize it ; but
in its course, from the impeded respiration, the
circulation of the blood through the lungs must
be hindered; hence, when during the first days
the inflammation has not been checked, and the
disease is violent, it easily spreads to the substance
of the lungs, and a peripneumony is formed, which
must be terminated by expectoration and other
critical symptoms. All the parts appearing in-
flamed in post mortem examinations, may be ex-
plained by the fact of the disease having proved
fatal, a proof that the inflammation had been vio-
lent, so much so as to affect all the structures, and
terminate in effusion or gangrene- In some rare
cases, when death has taken place at an earlier
period of the disease, from an entirely accidental
cause, these examinations give quite different
results.
This occurred in my practice seven years ago :
a female mendicant was taken into the hospital
on the third day after an attack of pleurisy ; she
had a fixed pungent pain on the left margin of
the sternum, between the fourth and seventh rib,
and the other symptoms of the disease; but as she
swarmed with vermin, they had before her admis-
sion cut off her hair, and besmeared the whole of
the head with mercurial ointment ; as we appre-
[ 84 :]
hended mischief from this rough treatment, her
head was forthwith washed with warm soap and
water ; on this and the following day (the fourth
day) to obviate the inflammation, venesection, to-
gether with the usual antiphlogistic remedies was
employed, and the symptoms thereby much re-
lieved ; yet on this day, at 5 p.m. she died sud-
denly and unexpectedly, for however apprehen-
sive we were about an unfavourable issue, still
there were no symptoms in the head which at all
announced it.
On examination, the vessels of the brain were
not found much injected, the plexus choroides
was pale, and a good deal of serum effused in the
ventricles. The lungs were found in a natural
state, and in general nothing uncommon in the
cavity, except just at that part where she had felt
the pain ; here the pleura was more red than usual,
the vessels surprisingly developed, and as it were
injected, and a gelatinous mass deposited on the
surface of the lung which lay opposite.
There were no pseudo-membranous formations,
shewing that in consequence of the treatment, the
inffammation was already disposed to resolution,
and which was interrupted by the unfortunate
event recorded ; a fresh proof of the mischief oc-
casioned by ignorant interference in the treatment
of diseases. These inflammations occur frequently
to all ranks of life, and should they be left to
themselves or negligently treated, they for the
most part tend to an unfavourable termination ;
and though their bad effects do not always appear
at once, difficulty of breathing, tightness at the
chest, and particularly chronic cough are often
their permanent consequences. Hence the phy-
sician should not quit his patient so long as any
c: 85 :i
trace of dyspnoea or cough remain ; how fre-
quently mild inflammations of this kind happen
and are overlooked, is proved by this, that in cases
where the thorax is examined after death, the
lungs are seldom found quite free, but generally
attached in various parts to the ribs, and more
particularly at their upper part. With regard to
the treatment of these inflammations, the healing
art has herein deserved well of mankind ; since even
the worst cases of these dangerous affections by
an efficacious but simple mode of treatment, (now
brought to a great degree of certainty) are for the
most part cured, and thus the lives of many thou-
sands saved. In pleurisy (and indeed in all in-
flammatory affections of the chest,) the maxim of
Baghvi deserves the greatest practical considera-
tion. ” In cases of pleurisy nothing so much re-
quires our most diligent attention as the patient’s
breathing, which, in proportion to its being more
or less free, announces a favourable or fatal issue
of the disease.” I shall be excused detailing so
many cases, by the frequent occurrence and im-
portance of these diseases.
PLEURITIS SPURIA.
There is, without doubt, a difference between
this and the rheumatic pleurisy ; the latter is de-
noted by a less violent febrile affection, and by an
unsteady wandering pain in the ])ieura costalis,
which may sometimes be even more violent than
in the genuine pleurisy. The former, viz. the
Pleuritis spuria, has its seat in the intercostal
muscles, and the patient cannot bear handling of
the affected part, which is often swollen, in this
also respiration is much less disordered. The
fever may assume a genuine inflammatory or rheu-
I
c 86 ;]
matic character ; and this inflammation may spread
to the pleura, and the disease thus become genu-
ine pleurisy.
Anna Pintona, a maid-servant, twenty-two years
old, was seized on the 2d of December, from tak-
ing cold, with headache and stitches in the left
side ; when admitted on the 4th into the general
hospital, she had shooting pains in the head, the
tongue somewhat eoated, she had thirst, and when
she drew in her breath, or moved her chest, the
pain on the left side was increased, where also
a swelling was perceptible ; which, from pain, did
not admit of being handled ; respiration was not
impeded to any degree, the pulse was accelerated,
somewhat full and hard. She had been bled
whilst at home ; at the hospital she had merely
Decoct. Althaeae cum Potass, nit. and an emollient
cataplasm. Even on the following day critical
appearances were observed in the perspiration
and urine, and the remaining symptoms were
much less violent. As she was of a costive habit,
half an ounce of sodae sulphas w'as added to the
mixture. On the 17th she left the establishment
quite well.
The following was a second case : —
Anna Bodynska, twenty-three years old, a
maid-servant, of middle stature, was attacked with
shivering and subsequent heat, to which were add-
ed headache and sharp pain on the left side, when
she coughed or made a deep inspiration ; the part
was painful to the touch and somewhat swollen,
the pulse frequent and soft, the fever very mode-
rate. She came into the clinical hospital on the
third day of her illness (the 2Sth of February),
Dec. xVlth. cum Pot. nit. et Roob Sambuci, with
emollient cataplasms, were ordered for her. The
C 87 ;]
fever soon subsided ; not so the pain of the side,
for which a blister was prescribed, and Dec. Alth.
cum Ext. Hyoscyami ,given. As the pain of the
head increased to a great degree, a blister was
also applied to the neck, after this the symptoms
gradually disappeared; and on the 17th of March
she left the hospital cured.
PLEURITIS RHEUMATICA.
Josepha Paul, twenty- two yeai’s old, a maid-
servant, was, on the 2d of March, after exposure to
cold, attacked wdth shivering and fever ; as head-
ache and pain in the side came on during the fol-
lowing days, she was received on the 6th of March
under our care. She complained of violent head-
ache, tightness and sense of burning in the eyes,
the cheeks were flushed in their circumference, the
respiration natural ; a more deep inspiration was
prevented by cough and wandering pungent pains,
which had now fixed themselves on the right side
of the chest ; the bowels were costive, the pulse
quick, full, and somewhat hard- R. Rad. Gram. 3j.
Rad. Alth. 5ij. coque per | hor. sub finem solve
mannae Colat. Jviij ; six leeches to the part af-
fected, emollient cataplasms and glysters. As on
the following day the pain was milder, but more
extended over the chest, a blister was applied
between the shoulders. On the 9th, the head-
ache became worse, and the pleuritic pains were
increased ; so that five cupping-glasses with scari-
fication* were applied to the part affected, and
a blister to the neck ; critical symptoms in the
• The German scarificator has nine small laacets, and the cup-
ping-glass contains about Jiss of blood.
C 88 3
urine and perspiration now appeared, and on the
12th she was discharged cured.
PLEURITIS GENUINA.
Maria Scopin, forty-five years of age, a char-
woman, sought, on the 1st of February (the sixth of
her illness) relief in the general hospital for violent
pleuritic pains. The breathing was short and
hurried ; a deep inspiration was prevented by its
producing a pungent pain in the chest, which was
attended with a dry cough ; the fever was high,
the pulse very frequent and hard. Prescribed, to
be let blood to eight ounces, emollient cataplasms;
and as the bowels had not acted for two days,
emollient glysters ; inwardly, Dec. Alth. cum Pot.
nit. et Syr. Alth. The blood was covered with a
thick tenacious coat. On the following day the
fever was more moderate, but the pleuritic pain
still great; six leeches were applied, and the bleed-
ing afterwards from the wounds encouraged as
much as possible by the repeated application of
sponges dipped in warm water. As the pain did
not still entirely remit, on the following day a
blister was applied to the parts, by which all com-
plaints were removed. On the 5th of February,
the eleventh of her illness, the urine appeared sa-
turated, and soon threw down a sediment ; and on
the 8th, she left the hospital almost entirely res-
tored to health.
PLEURITIS CUM ABORTU.
A charwoman, thirty years old, of a weakly habit,
three months gone with child, was, on the 25th of
January, in consequence of carrying heavy bur-
thens, seized with pains in the back and abdomen.
She had shivering, with subsequent heat and
c: 89 3
nausea ; abortion soon followed, with considerable
haemorrhage.
On the 6th of February she came into the ge-
neral hospital; she complained of pain in the head,
her countenance was pale from loss of blood, great
thirst, white tongue, the breathing not much im-
peded, though a deep inspiration M^as interrupted
by a dry cough, and a pungent pain on the left
side of the chest; the breasts were flaccid, the
abdomen soft ; near the pubes it was painful to the
touch, the pulse was frequent, tense, and some-
what hard ; she could not lie on the left side. As
this weakly patient had already suffered a consi-
derable haemorrhage, and as she had just been
brought from her home, a mild antiphlogistic
treatment was adopted; and Decoct. Althasae, with
half a drachm of nitre and emollient cataplasms
were employed, in the hope that nature, in this
case, would of herself bz’ing about a favourable
change. In I'act, during the three following days,
this expectation seemed to be realized, as she
could make a deep inspiration without pain, and
the other pectoral symptoms were considerably
improved. Yet, on the 11th, the difficulty of
breathing had become worse, the pain at the breast
more violent, the cough more troublesome ; there
was anxiety, and the pulse tense and oppressed.
Ordered, six ounces of blood to be taken (for not-
withstanding the previous haemorrhage this could
not be dispensed with), and Mist. Amygd. cum
Potassae nitrate.
On the 1 2tb, her state was more favourable, the
fever was not so high, the pleuritic pain was also
less, but still violent ; six leeches were ordered to
the affected side.
On the 15th, she had passed a bad night; the
I 3
c 90 :
difficulty of breathing had increased still more;
she could not make in a deep inspiration for the
pain; the pulse became again hard and tense.
Ordered, another bleeding to four ounces, she went
on with the medicine ; and a powder with half a
grain of calomel was given every four hours. On
the day following, leeches were again applied, by
which the inflammation was lessened, the breath-
ing became free, the violence of the pain was di-
minished, and afterwards entirely disappeared;
the emollient remedies were continued for some
days. On the 25th, she left the establishment
cured.
PLEURITIS SINISTRA CUM SPASMIS.
Johanna Hoffmann, a maid-servant, of a weak
habit, sixteen years old, was, on the 9th of Feb-
ruary, after exposure to cold when heated with
dancing, taken with shivering, subsequent heat,
and great languor ; tow’ards the evening she felt a
violent stitch on the left side of the chest, which
was increased by inspiration. As these symptoms
daily got worse, she was taken into the clinical
Jmspital on the fourth day of her illness. The
following was her state : violent pain in the temples,
vertigo, flushed face, white tongue, great thirst,
hurried breathing, pungent pain in the left side,
which was increased both by a deep inspiration,
and by external examination of the part; the cough
was not frequent, nor did it much increase the
pain, the breathing w'as hurried, she could not lie
on the right side, the skin was moist, the pulse
frequent, full, and tense ; six leeches were applied
to the seat of the pain ; Decoct. Alth. cum Pot.
nit. et Sacch. together with emollient cataplasms.
The inflammation, however, increased on the fol-
C 91 3
lowing day, the breathing became more difficult,
a dry cough came on, and moreover convulsive
spasms of the upper extremities, very like the fe-
brile symptom of picking the bed-clothes, were
observed. Blood was taken to six ounces, which,
notwithstanding the spasms, was urgently indi-
cated ; she went on with her mixture, and took
also Zinci Oxyd. gr. ss. every three hours.
On the sixth day, a very slight epistaxis took
place ; as the relief was trifling, six leeches were
applied in the evening, and a blister between the
shoulders.
On the seventh day the spasms abated ; a deep
inspiration still produced pain, the urine was tur-
bid, the pulse frequent. Six more leeches were
again applied and repeated the day following, as
towards evening the pains of the chest had in-
creased. The chest was now' relieved, but in its
stead, increased headache, vertigo, ringing and
pain in the ears became the prominent symptoms ;
the tongue was covered with a white mucus, the
thirst was moderate, the pain of the side again in-
creased, the pulse moderately frequent, contracted,
and rather hard. She had leeches applied to
both sides of the chest, the bleeding encouraged,
and the cataplasms continued. Considerable im-
provement at last took place, the pains in the
head and side disappeared, the breathing became
quite free, the skin perspired abundantly, and a
slimy sediment was observed in the urine.
On the thirteenth day, the disease terminated
by crises, the urine for some days threw down /,
a copious sediment, w’ith a vitreous crust, and
lastly re-assumed its yellow colour, all the func-
tions returned to their natural state, and on the
eighteenth day she was discharged cured.
c: 92 ;]
PLEURITIS ET BRONCHITIS CUM TUSSI CHRONICA-
A robust and corpulent maid-servant, eighteen
years old, had been for more than half a year sub-
ject to a chronic cough, which was sometimes
better, at others worse ; in April she was seized
with a sharp pungent pain in the left side of the
. chest, could not breathe but with difficulty, and
when she coughed, the pain was much increased.
When on the 2Sd of April she came into the
hospital, her face was flushed, and verging to blue
when the cough attacked her. She was pre-
vented lying down from anxiety and pain, the
fever was violent, the pulse full and rather hard.
She was bled to eight ounces, which, on the
following day was repeated to six ounces, emolli-
ent cataplasms were applied, and Dec. Alth. cum
Pot. nit. et Rooh Sambuci, given. The blood
on each occasion assumed the inflammatory coat.
The symptoms were considerably relieved, the
cough and pain of the side less violent. On the
27th, Decoct. Alth. cum Ext. Hyoscyami gr.ij. was
ordered, to quiet the still troublesome, dry, hollow,
bronchial cough ; but as this was insufficient.
Decoct. Sem. Lini. cum Ext. Hyoscyami gr. ij.
and a powder with half a grain of calomel was
given three times a day. Emollient cataplasms
and vapours for inhalation, leeches, and lastly,
Ungent. Antim. tartariz. were employed. The
relief was but trifling, the fever had somewhat
abated, but the cough remained nearly the same,
extremely obstinate, and so violent, that the mus-
cles of the face were contracted when it came on.
Potass, sulphuret. was now had recourse to, given
in doses of two grains in a wafer every three hours,
afterwards increased to three grains, according to
n 93 ;]
the following prescription. R. Potass, sulphuret.
gr. iij. exhibeantur in LagenA minimi, epistomio
bene claus&, et clentur tales doses, No. sex ; a
powder to be taken in a wafer every three hours.
Decoct. Sem. Lini was besides given. The event
was very propitious. After some days the cough
was so much subdued, that the patient could
breathe freely, draw in a deep inspiration, and lie
in any posture. After ten days, however, from
an imprudent exposure to cold when in a state of
perspiration, the cough was brought on with its
former violence. Blisters, emollient remedies, and
the repeated use of calomel, fortunately overcame
it. After a two months treatment, she was able to
return to her service, and cured of her chronic
cough.
PERIPNEUMONIA GENUINA.
Theresia Slawick, seventeen years old, a semp-
stress, was troubled for several weeks with a cough.
On the 7th of March, without any assignable
cause, she was seized with shivering and heat, and
during the night she had violent pains in the spine,
with ringing in the ears, and wandering: there
was great anxiety, tightness and sense of weight at
the chest, together with a constant inclination to
cough. In this state she came, on the 8th of
March, into the clinical hospital. The face was
flushed and hot, the eyes animated and sparkling
the breathing short and hurried, interrupted by
cough and pain, and by which a deep inspiration
was prevented ; there were some streaks of blood
in the expectoration, the pulse was very frequent,
small and oppressed. Ordered, to be let blood
to eight ounces, emollient cataplasms to the chest ;
inwardly, Dec. Alth. cum Pot. nit. et Syr. Alth.
c: 9 4 ;]
On the 9th, the difficulty of breathing and
the oppression at the breast had diminished, as
well as the tinnitus ; the pulse was quick, more
developed, and not hard. She had had no stool,
for which an emollient glyster was ordered, also to
go on diligently with the mixture and cataplasms.
On the 11th, the urine shewed a copious sedi-
ment, her general feeling was much improved, the
breathing more free, but the cough was trouble-
some at night; ordered. Rad. Alth. ^ss; f. Dec.
cui infund. Flor. Papav. Rhaed. 5u 5 Colat.
adde Syr. Alth. ^ss; with the continued use
of this remedy, the patient perfectly recovered,
and was discharged on the 20th of March.
The following was another case : —
Appolonia Zatoken, twenty -two years old, had
been in her service exposed to much toil and
hardshijD, and fell into an inflammatory fever.
When she came into the hospital on the 1 1th of
April (the fourth day of her illness) she complained
of great stupor, difficult breathing, with a sensation
as if a weight lay upon her breast, she had a con-
stant hacking cough, expectorated httle, and this
was streaked with blood, the pulse hard and full.
Ordered, to be let blood to eight ounces, emollient
cataplasms, and Decoct. Alth. cum Pot. nit. ; thin
almond emulsion for her drink. The blood formed
a thick inflammatory coat, the oppression was
somewhat relieved ; but on the day following be-
came as violent as ever ; a second blood-letting of
eight ounces procured more permanent relief.
On the sixth day of the disease the urine separated,
and for some days threw down a sediment ; during
the night she perspired ; the pain, however, had
not entirely disappeared from the breast, and she
complained of not being able to breathe so free
n 95 :]
as before ; a blister on the sternum x’emoved this
sense of oppression ; for some days the bowels had
not acted, glysters were in vain used, for this a
solution of Glauber’s salt in Decoct. Alth. was
given, which produced four evacuations ; her re-
covery now daily advanced ; and on the 28th of
April, she was sent home cured.
PERIPNEUMONIA CUM AFFECTIONE DIAPHRAGMATIS.
Johann Peschata, a shoemaker’s apprentice,
fifteen years old, of a cachectic appearance, was fre-
quently exposed to atmospheric changes; he usually
went with his breast uncovered, and too suddenly
out of a warm room into the cold air. He was taken
with shivering and heat, and when, on the 19th of
March (the ninth day of his illness), he came into
the clinical hospital, he complained of a violent
oppression at the breast ; his breathing was diffi-
cult, by which too the thorax was but little raised.
On making a deep inspiration, a dry cough was
brought on, he had also pungent pains about the
diaphragm, the hypochondria were drawn in, the
cutaneous heat was increased, the secretions dimi-
nished, the pulse frequent, somewhat hard and
oppressed. Ordered, blood to be let to five
ounces, emollient cataplasms, and Mist. Amygd.
Considerable relief followed the bleeding, the
breathing was more free, the pulse less frequent,
fuller and softer. In place of the oppression, the
patient complained of a sensation of burning in
the course of the sternum. Decoct. Alth. cum
Sacch. and a blister to the breast were ordered,
by which this symptom was relieved. But now he
began to complain of headache, and had no sleep^
A blister to the neck procured relief. To effect
some change in his cachectic appearance. Decoct.
i; 96 1
Polyg. amar, and afterwards Decoct. Cinchonae
cordifol. was given. He soon acquired a healthy
look, gained flesh, felt himself strong, and after
five weeks left the hospital, happy in the recovery
of his health.
PERIPNEUMONIA CATARRHALIS SCBSEQENTIBUS
MORBILLIS.
Mathias Stora, a school-boy, eleven years old,
was, at the end of April, taken, after preceding
shivering and heat, with pain in the head, and a
sense of weight at the chest ; he coughed much,
and expectorated a quantity of grey mucus. When
on the 3d of May he came into the hospital, he
had violent pain in the forehead, tinnitus in the
left ear, dry lips and tongue, and great thirst j he
breathed short and quick, with difficulty, and
complained of pressure in the chest, which, when
he attempted to make a deep inspiration, was in-
creased, and brought on cough ; this was dry, the
skin hot, the fever violent, the pulse uncommonly
quick, though not hard; his countenance pale and
puffed up, gave the disease an uncommon aspect.
During the two following days, the measles came
out; four leeches were applied to the chest, and
Dec. Alth. cum Pot. nit. et Roob Sambuci was or-
dered. The eruption was attended with delirium
at night, spread very regularly, and disappeared
gradually, with sweating, and pale yellow urine
with slimy deposit, by the 9th. But now a truly
inflammatory affection of the windpipe came on,
which spread itself into the ramifications of the
bronchia (Bronchitis catarrhalis.) The cough be-
came barking and hollow, and the pulse more fe-
verish ; two leeches were applied to the neck,
emollient cataplasms and a gargle ; he took Dec.
c: 97 ;]
Alth. ; Pot. nit. gr. xij ; Ext. Hyoscyami gr. ij ;
Ext. Glycyrrh. 5j. But afterwards, in its stead,
Decoct. Sem. Lini, and powders with one-third of
a grain Fol. Digital. Lastly, (17th May) powders,
with Potass, sulphur, gr. ij. every three hours,
which last produced a most striking effect ; the
barking cough ceased, a copious puriform expec-
toration followed, all fever disappeared, the urine
became turbid, as if mixed with clay, and threw
down "a sediment. On the 22d, he went home to
his pai’ents quite well.
PLEUROPERIPNEUMONIA CUM ANGINA TONSILLARI.
John Kohler, twenty- two years old, a coach-
man, and of pretty strong habit of body, heated
himself with his work, and drank cold beer : on
the evening of the same day he had shivering and
heat, which continued; he had no sleep during
the night, but great pain in the head ; towards
morning he felt pain on swallowing, and violent
pungent pain on the right side of the chest, nor
could he cough without great increase of the pain.
On the third day a surgeon bled him, but he
was no better ; and on the 2d of J une (the fifth
day of his illness) he came into the clinical hospital :
the pain of the chest still continued, and under the
sternum he felt also a sense of weight ; he could
not draw in his breath, and he coughed with great
labour. The tonsils were enlarged, as well as the
uvula and velum pendulum, his deglutition was
difficult, his expectoration streaked with blood,
the pulse oppressed, rather hard and fi’ecpient ;
ordered, blood to be taken to eight ounces, emol-
lient poultices. Decoct. Alth. cum Pot. nit. four
leeches to the neck, and an emollient gargle ; with
repose, strict diet, and the diligent use of these
K
c; 98 3
remedies, the inflammatory symptoms of the throat
and chest soon decreased ; a crisis appeared in the
expectoration, in the urine, and in a copious per-
spiration, which lasted for several days. On the
twelfth day after his admission, he was able to re-
turn to his service.
In this case the pleura was first inflamed ; but
in the course of the disease the lungs also ; being,
however, in other respects of a sound constitution,
the inflammation was readily overcome.
PERIPNEUMONIA IN FEBREM NERVOSAM TRANSIENS.
Maria Werch, a maid-servant, twenty-six years
old, had brought on fever by getting cold, to which
was soon added a dull pain in the head, great
thirst, and a sensation of pressure and tightness
about the sternum, with cough. On the 9th of
January (the fourth day of her illness) she came
under our treatment, she complained of a conti-
nued oppressive pain, as though a weight was laid
upon her chest ; could not breathe deep without
bringing on cough and increase of the pain ; she
expector ated some slimy matter mixed with streaks
of blood ; the skin was dry, the pulse very fre-
quent, oppressed and small. Ordered, blood to be
let to eight ounces, cataplasms to the breast, and
Decoct. Alth. cum Pot. nit. et Roob. Sambuci.
In the evening she was still much troubled with
the cough, the other complaints of the chest wei’e,
however, diminished; and the bloody expectora-
tion had disappeared. On the third day there
was for this ordered a linctus, with Syr. Alth. et
Gum. Acacias, and a blister to the sternum ; and
on tlie fourth day the Emulsio Gummosa. The
affection of the chest became better, but a sinking
of the pulse gave reason to fear that a nervous
C 99 :
state was forming, the tongue became dry, the
skin ceased to perspire and was hot; the expec-
toration was with difficulty brought up ; ordered,
Dec- x\lth. cum Oxymel- also Pulv. Rad. Ipecac,
gr. ij. Sulph-sublira. gr. vj. Sacch. pur. iii* f-P-
divid. in dos. No- sex. a powder every three hours.
On the 18th, the patient complained of swimming
in the head, the lips were covered vvith a brown
crust, the thirst increased, the breathing was free,
the pulse contracted and small ; six leeches were
applied to the sternum ; after the bleeding had
ceased, a large sinapism both to the chest and to
the calves of the legs. Notwithstanding this, the
nervous character became more developed, the
head was oppressed with stupor, the countenance
pale, the lips united with a black paste, the tongue
red and quite dry ; the affection of the chest was
less, and the abdomen pretty free, the stools soft,
the pulse very frequent, small, contracted and
weak : a linctus, with gum arabic and oxymel ol
squills, was ordered ; also a blister to the lower
extremities; then Decoct. Alth. cum Camph.gr. ij.
et Oxymel. simp, given ; and to relieve the labo-
rious expectoration, poAvders with Antim. Sulph.
praecip. gr. ss. every three hours. During the use
of these remedies the pulse rose, she had gentle
perspiration at night, her thirst diminished, the
head became freer, the tongue by degrees moist
and cleaner, and the urine, which was pale red,
threw down a sediment. Dec. Alth. cum Decoct.
Polyg. amar. was now had recourse to ; and finally
Cinchona Avith Polyg. Amar. by Avbich remedies
the patient gradually recovered ; but it required
about a month before she Avas sufficiently strong
to return to her service.
C 100 2
PLEUrtITIS ET PERICARDITIS.
How difficult the treatment of diseases by me-
tastasis is, and how completely they often set at
defiance every effort of our art, will appear from
the following case : —
An active butcher’s boy, twenty-six years old,
was attacked with an inflammatory erysipelatous
swelling on the right arm, which, during the use
of cold applications, disappeared on the seventh
day ; but in its stead, violent afiections of his chest
came on, with which he was admitted, on the 22d
of November, into the clinical hospital. The fol-
lowing was his state : he complained of violent
pungeiit pains on the left side of the thorax, which
extended to the right hypochondrium, in which
place he could not bear the slightest handling;
when he breathed deep, cough was excited, which
was attended with a blackish expectoration streak-
ed with blood; the pulse was hard and oppressed,
the aspect yellow, the tongue charged, the taste
bitter. It was resolved to take away ten ounces of
blood, and to apply six leeches to the region of
the liver, a sinapism to the arm, and to give him
Dec. x\lth. et Graminis cum Potass, tart. He was
not thereby relieved, the inflammation appeared
to extend still more to the dirphragm and peri-
cardium ; hiccup came on, the tightness increased
to a great degree, his breathing was very difficult,
the expectoration streaked with red blood, there
was great restlessness and anxiety, the pulse very
quick and irregular, but always hard ; the inflam-
mation acquired such violence, that repeated
blood-lettings were urgently called for, five of
which were bad recourse to; and at each of them
the crassainentum assumed a thick inflammatory
C 101 3
crust. Moreover, the employment of leeches was
frequently repeated, and all other antiphlogistic
means used in their greatest extent ; blisters and
sinapisms were applied, glysters injected, calomel,
and afterwards digitalis, given ; but the inflam-
mation pursued an uncontrouled course ; nervous
symptoms came on, the pulse became so frequent
as not to be counted, and still the inflammation
acquired renewed force ; the oppressive pain of
the breast was more violent, the breathing short
and extremely painful, and he could not rest but
with the chest raised.
Our art stood now on its limits, powerless and
exhausted, a Decoction of Althaea and Polygala
senega ; a camphorated emulsion, renewed blis-
ters and stronger sinapisms, lastly musk, were the
last arms employed to contend with this dire dis-
ease, and which bid defiance to every treatment ;
the countenance became hippocratic, the pulse
not to be counted and trembling ; the patient died
on the twelfth day after his admission. On open-
ing the body, tbe whole cavity of the chest was
filled with a coagulated caseous matter, and the
surface of the lungs covered with it as with a coat;
they were firmly attached to the ribs, the right
lung was as if dried up ; the left one firmer than
usual ; the inner surface of the pericardium en-
tirely covered with exudation and flaky masses ;
it contained also a considerable quantity of water ;
the surface of the heart itself in its whole extent
was covered with thick pale yellow tresses, which
gave it quite an unnatural appearance ; (Cor vil-
losum) its substance shrivelled ; in the right ven-
tricle there was a small coagulum. The liver
was enlarged, so as to exceed the usual bulk by
one-third.
K 3
L 102 ]
INFLAMMATIONS OF THE ABDOMEN.
Inflammations of the liver, peritoneum, intes-
tines, and occasionally puerperal fever with its
various modiflcations, are what most generally
occur under this head.
INFLAMMATION OF THE LIVER.
Inflammations of the liver, the largest viscus of
the abdomen, and the most replete with blood,
frequently occur ; and occasionally with great
acuteness. The convex surface of this organ is
by much the most subject to inflammation, and it
has a great resemblance with that of the right
pleura, and this from the same darting pain which
is increased by a deep inspiration, and excites
coughing. The inflammation of the concave part
of the liver is more rare in this country ; it is at-
tended with tension, anxiety, nausea, eructation,
and symptoms of jaundice to a great degree. It
is easy to confound this with bilious fever ; an
error in practice of great consequence ; as eme-
tics, which in cases of inflammation would be per-
nicious, might, on the contrary, in those of bilious
fever, be of great use.
In doubtful cases it is always more safe to adopt
an antiphlogistic plan, combined with laxative re-
medies, and the more so as bilious fevers are at-
tended with a state of irritation which is easily
urged into inflammation. The treatment in clear
cases is not difiicult ; it consists of antiphlogistic
remedies with topical, or in violent cases, general
blood-letting ; laxative remedies, as Althaea, Gra-
men, Tamarindi, Pruna, Potassje tartras, emol-
lient cataplasms, and glysters, which last are more-
over useful by serving as a fomentation when
C 103 3
thrown into the colon ; but when, after the vehe-
mence of the fever is abated, and only partial ob-
structions remain, as also in cases of chronic in-
flammation, calomel, and mercurial friction, have
a very beneficial effect.
HEPATITIS.
Anna Herzogen, a maid-servant, twenty years
old, was, without being able to assign a cause,
seized with shivering and heat. She had pains in
the belly, which became fixed in the right hypo-
chondrium. When on the 3d of February, she
came under our care, she complained of head-
ache, she had a slimy taste, and eructation, the
tongue was white ; when she drew in her breath,
the pain in the right side was greatly increased ;
this part was perceptibly swollen, and painful to
the touch ; she had had no stool for some days,
the pulse was moderately frequent, full, and soft.
Ordered, six leeches to tlie region of the liver,
emollient cataplasms and glysters, also Dec. Alth.
Oss ; Mannae 5j> It was necessary from increase
of the pain to apply eight more leeches; the urine
became turbid, and the pains with this treatment
gradually disappeared ; Ammonias mur. 9j. was
now added to the mixture, with the continued use
of which, for several days, the tongue became
clean, the appetite returned, and on the 19th she
left the hospital cured. The presence of gastric
impurities, could not here be doubted, yet an
emetic would in the inflammatory state of the liver
have been highly prejudicial.
HEPATITIS RHEUMATICA LEVIS.
Ilosina Klimin, twenty years old, a maid-ser-
vant, was, on the 26th of November, without as-
C 104 ;]
signable cause, taken w'ith fever ; she soon felt a
fulness and tension on the right side of the abdo-
men, which ended in sharp pains. On the 4th
of December she came into the clinical ward.
She complained of headache, bitter taste, the
tongue was coated, she had pricking pains in the
right hypochondrium, which were increased b)’
making a deep inspiration, and by handling the
part, they extended to the right shoulder ; neither
tumour or hardness was perceptible ; the pulse
was moderately frequent and full. Ordered, De-
coct. Alth. cum Pot. nit. et Roob. Sambuci ;
emollient cataplasms to the region of the liver and
glysters. Within four days all symptoms of inflam-
mation had disappeared, and a crisis took place
with abundant perspiration.
HEPATITIS CHRONICA.
Anna T. twenty-five years old, a chamber-maid,
of a moderately robust and phlegmatic habit, en-
joyed up to her twenty-fourth year tolerably good
health ; at which period she had an inflammation
of the liver, and which not having been entirely
removed, had, for a year, caused her much suffer-
ing. An irregular state of the bowels, at one
time constipation, at another diarrhoea, loss of ap-
petite, compression, tightness, fulness, and fre-
quently returning pains in the liver, palpitation of
the heart, a yellowish pale countenance, and leu-
corrhoea, were the symptoms which presented
themselves. By examination the liver was felt to
be evidently enlarged. The cure was begun with
Decoct. Gramin. cum Inf. Glycyrrh. and emol-
lient cataplasms ; afterwards. Decoct. Taraxaci,
with a powder containing half a grain of calomel,
twice a day, also frictions with Unguent, hydrar-
c: 105 ]
gyri et digitalis ; next Plummer’s Pill, and when
costiveness occurred, a neutral salt, as sulphate of
Soda, or of Magnesia, was added to the mixture ;
which, when the bowels were regular, was changed
for the Muriate of Ammonia; for the Leucorrhcea,
frequent ablution, and afterwards injections of De-
coct. Querchs, cum Altimine were employed. By
the long continued use of laxative remedies, as De-
coct. Graminis cum Potass, tart, vel Supertart, or
Decoct. Cichorei ; and lastly. Inf. Anth. cum Tinct.
Rhei aquos&, she was freed from her complaints ;
there was no longer any tumour to be felt, the leu-
corrhoea had ceased, her menses had regularly
appeared, she had acquired a blooming, sound
aspect, had an excellent appetite, and good diges-
tion, with a regular alvine excretion"; she left the
hospital cured in two months. In this case the
calomel readily brought on diarrhoea, but taken
in combination with Sulph. ant. praecip- she bore
it well ; generally speaking in such chronic in-
flammations of the liver, the physician must not
be impatient; by a continued and well directed
mode of treatment one is able even in very diffi-
cult cases often to bring about unexpectedly, the
most happy results.
HEPATITIS GRAVIOR.
M'illiam M. twenty-two years old, a student in
surgery, during a dispute, got into a violent passion,
and drank cold water ; during the night he had
shivering and subsequent heat, headache, and an
oppressive pungent pain in the right hypochon-
drium ; a physician ordered a blister, and some kind
of purgative electuary, which gave no relief. On the
‘Id of July, (the fifth day of bis illness) he came
into the hospital. The face was flushed and
c 106 ]
swollen, the eyes animated, the tongue white, the
taste insipid, with great thirst, the breathing very
frequent without cough, an attempt at a deep inspi-
ration brought on increased pain in the region of
the liver, where handling gave great pain, and a
swelling was apparent ; the pain extended into the
right shoulder, he could not lie on the right side,
the external heat was much increased, the urine
of a dark red colour, the pulse quick, hard and
oppressed. He was bled to eight ounces, and
towards evening six leeches were applied to the
affected side, emollient cataplasms, and Decoct.
Alth. mannat. were ordered.
He was hereby somewhat relieved, but did 'not
continue so ; for on the following day, the symp-
toms had increased in violence, he had great rest-
lessness and anxiety ; he coughed with straining,
and increase of the pain, which now extended to
the right breast, the respiration was very rapid,
painful and unequal, for the right side of the chest
was scarcely at all elevated ; he complained most
of the pain between the seventh and ninth ribs of
the right side. The bleeding was repeated to
eight ounces, and as at the evening visit, the
symptoms were nearly the same, and the blood
covered with a thick inflammatory crust, six more
ounces of blood were taken, and the following
ordered: — Had. Alth. ^ss. Rad. Gramin. f.
Decoct. Colat. 5'dij. adde Potass, tart* 5ij ; Mellag.
Gramin. 5ss. He was able to get several hours
sleep during the night, still the cough was very
troublesome, which increased the pain of his chest;
the fever, however, had on the following day much
abated. Six leeches were ordered to the right
side, which in the evening and during the day
folio wing were four times repeated, on account of
c: 107 ;]
the still fixed pain in the liver and right breast.
We had now recourse to calomel in doses of
half a grain thrice a day, to friction, with the
ointment of hydrargyrum and digitalis, to blis-
ters and the warm bath.
On the 14th, he bled from the right nostril;
this night the urine separated, and threw down a
white deposit; but it required some time before
all painful feeling in the region of the liver disap-
peared ; on the tw'enty-eighth of the month, he
left the hospital cured.
INFLAMMATION OF THE SPLEEN.
This is not a frequent inflammatory affection ;
it has this in common with hepatitis, that it is fre-
quently attended with gastric affections ; and with
pain of the shoulder, but here on the left side.
The treatment too agrees with that observed in
inflammation of the liver ; in examinations of those
who have died of this disease, traces of previous
inflammation of the spleen have always appeared.
This year two cases happened, of ivhich the
following ended fatally; —
Jahelkin Thekla, thirty-three years old, a maid-
servant, came on the 29th of January, 1823, (the
fourth day of her illness) into the hospital. She
believed that she had taken cold ; her sickness had
begun with shivering and subsequent heat, ac-
companied with eructation and tendency to faint,
a violent dragging pain In the belly, more particu-
larly in the left hypochondrium, which extended
itself upwards to the left shoulder, and downwards
to the left knee. The aspect of the patient was
of a genuine livid colour; in the region of the
spleen there was perceptible a pretty large and
hard tumour, which did not admit of the least
c: 108 ;]
pressure, and which was evidently that viscus en-
larged. The taste was bitter, the tongue white,
she could not lie on the right side, and had violent
fever.
Six ounces of blood were taken, leeches and
emollient cataplasms applied ; she took Decoct.
Alth. cum Potass, tart, et manni ; and afterwards
powders, with half a grain of calomel ; mercurial
friction, and baths were also had recourse to.
She was something better, the swelling de-
creased, the pains were diminished. On the
twenty-eighth day of her illness, the feet and face
began to swell, the urine was scanty but without
pain ; though she still complained of pain about
the spleen ; diuretic remedies were now combined
with the antiphlogistic. Decoct. Alth. cum Tinct.
Digital, et Oxymel ; the swelling continued to di-
minish, but did not disappear. On the forty-first
day, she was seized with violent spasms ; in con-
sequence of mental agitation from a dispute with
her friends, she lost her speech, and was almost
suffocated. Decoct. Alth. cum Ext. Hyosciam.
and powdei’s of Castor and Zinci. Oxyd. were
prescribed, and a sinapism to the pit of the sto-
inach. She came about, but the paroxysm re-
turned, and was so violent as to border upon
general palsy, the limbs were motionless, the stools
and urine came away spontaneously. Infus. Flor.
Arnicas, cum Tinct. Castorei et Liq. Ammon,
subcarb. was given, and frictions with Spirit
Camph. and Tinct. Canthar. made on the extre-
mities- She was once more relieved, speech and
motion returned, but a violent diarrhoea, with loss
of blood, came on, and she fell into a state of
great debility. Aq. Menth. Meliss. aa ^iij ; Tinct-
Cinnam. 5j ; Rais. vit. Hoffman, 9ij; Elaeosacch.
c 109 3
Menth, pip. 5ij ; afterwards, Ipecac, gr. iij. My-
risticae N. gr. xij. P. Trag. Comp. 5ij. f. Pulv. di-
vid. in dos. No. sex — one to be taken every three
hours. Glysters with starch and laudanum were
ordered, but the diarrhoea continued, and her
strength sank ; the following was given, Aq. Meliss.
3vj; .^ther. Sulph. 5ss; Tinct. Opii. nt xij ; Tinct.
Aurant. 5j. and powders with a grain of camphor,
but she died in the seventh week.
On opening the body, evident marks of previous
inflammation of the spleen were found, and exuded
lymph in the form of threads and membranes ; yet
that viscus was in its texture natural ; the left kid-
ney much enlarged, and adhering to the spleen
and small intestines ; its texture much deranged,
as if sphacelated and containing extravasated blood.
In the middle and lower part of the small intes-
tines, there was a quantity of coagulated black
and putrid blood — there were calculi of different
sizes in the gall-bladder.
PERITONITIS.
Females are most subject to inflammations of
the peritoneum ; of which their manner of cloth-
ing themselves, the greater chance of taking cold,
the irritable state of the uterus during menstrua-
tion, and the period of parturition, are considered
the chief causes.
There is no inflammation which assumes so
many forms as that of the peritoneum, as this
serous extensible membrane, in the form of a closed
bag, by its duplicatures forms the omentum and
mesentery, and lines almost the whole cavity of
the abdomen, and with the exception of the lower
part of the rectum covers all the digestive organs
contained therein, and in females also, the upper
L
C 110 ]
part of the womb, the fallopian tubes and ovaries.
It hence readily partakes in the inflammation of
all these organs, so also its inflammation is often
propagated to their surfaces. Hence the distinc-
tion of peritonitis anterior, dorsalis, lumbaris, from
inflammation of the omentum and mesentery.
The peritoneum too, in puerperal fever acts a
prominent part. There is also a chronic inflam-
mation of this investing membrane. It lurks under
the mask of various affections of the lower belly,
such as hysteric fits, cramps of the stomach, colic,
or gripes. Dropsies, indurations, and other ad-
ventitious structures, are not unfrequently occa-
sioned by an inflammatory state of this membrane,
which is so much more readily communicated to
the abdominal viscera, as it either covers, or is
attached to all of them.
The seat of the pain and the absence of the
essential symptoms of inflammation of any parti-
cular viscus form the diagnosis.
PERITONITIS ANTERIOR.
Veronica Maretschekin, thirty-years old, a
married woman, suffered abortion from violent
exertion of the body, in the third month of her
pregnancy ; she lost much blood at the time, and
the lochia flowed pretty freely for eight days ;
she returned notwithstanding to her occupation,
and then first perceived pains in the belly, which
extended themselves from the navel towards the
pubes and loins. On the od of Januar}’, she came
into the general hospital ; she coulil not bear the
slightest pressure of the hand on the abdomen,
over which the pain extended itself completely,
it was swollen and tense ; she was costive, her
pulse frequent and small. That extravasation
c: 111 :]
had liere already taken place might be concluded
from the continuance of the disease, and from the
state of the abdomen ; yet the inflammation con-
tinued in a high degree ; the fever was moderate.
Six leeches were applied to the abdomen, emolli-
ent poultices, glysters and Decoct. Alth. cum
Mann& were ordered. On the following day, as
the bowels had not acted, half an ounce of sul-
phate of magnesia was given in Mist. Amygdalae.
The pains had somewhat diminished. On the 9th,
the dose of the salt was increased to six drachms,
by which some evacuations were procured. On
the 10th, half a grain of calomel three times a
day, and Decoct. Alth. was ordered. Several
loose evacuations took place, with which came
away an uncommonly great quantity of puriform
matter, like coagulated lymph ; in the urine also
there w’as a copious sediment of a similar nature ;
the belly soon subsided, became soft and free from
pain. On the 16th, the calomel was laid aside,
the patient having no further complaint ; Decoct.
Lichen cum Roob. Dauci was ordered, and con-
tinued for some time, or till she recovered her
strength. On the 1st of February, she went home
cured.
PERITONITIS RHEUMATICA.
A robust servant-maid, seventeen years old,
began to menstruate in her fifteenth year, this
evacuation ceased the year after without cause,
and had not since appeared. On the 4th of Feb-
ruary, she experienced pains in her belly, attended
with shivering and heat; these intermitted, but
did not entirely relieve her ; during a fortnight,
she attended to her service, but her case at last
became so bad, that she could not quit her bed.
c 112 ;]
On the 20th of February, this patient came into
the general hospital. She complained of dragging
pains through the whole abdomen, which did not
admit of the least pressure ; the belly was tense,
the fever moderate. Six leeches and poultices
were applied to the belly, and oily glysters ordered.
She took Decoct. Alth. mannat. She was much
relieved by the loss of blood.
On the 22d, she experienced acute pains in the
left shoulder ; a blister between the shoulder
blades procured relief. As frequent loose stools
had come on, Decoct. Salep. spiss. cum Syrup.
Papav. was ordered. On the 24th, she had pun-
gent pains in the left side of the breast, and also
again in the left shoulder ; a blister was applied
to the sternum. On the 26th, a sediment ap-
peared in the urine, the patient had perspired a
little during the night : to assist nature in her
critical efforts by the skin, the following was or-
dered. Stip. Dulcamar. ^ij ; ft. Infus. fei v. jviij ;
adde Sacchar. pur. 5ij. She afterwards took Plum-
mer’s powder, (Hyd. sub. et. Sul. Ant. pr. p. cs.)
and lastly, a solution of Glauber’s salt, to coun-
teract costiveness, and she recovered. Suddenly
on the 6th of March, she became worse ; she had
been imprudent in her diet, complained of head-
ache, bitter taste, eructation and tightness about
the stomach. As yet there was no fever. An
emetic with fifteen grains of Ipecac, and half a
grain. Ant. tart, was given, from which she vomit-
ed several times. Mild laxative remedies, as Dec.
Gram, cum Potass, sulph. were had recourse to,
and the sense of pressure at the stomach, which
lasted the longest, disappeared. Her appetite
returned. On the 12th of March she was dis-
charged cured.
n 113 ]
PUERPERAL FEVER.
It is not easy to imagine a more pernicious doc-
trine, than that, which holds that no other than a
state of debility and exhaustion in the female
constitution must necessarily be induced, by pre-
vious child-birth, and its concomitant pains, anx-
iety, and loss of blood ; yet if we consider atten-
tively and without prejudice, the process of
parturition, we shall come to a very different
conclusion. It is true that the increased vitality
of the mother during her pregnancy, and the sur-
plus of nutriment as far as the womb is concerned,
ceases at child-birth, but not so with the general
habit ; and the breasts, which have so great a
sympathy with that organ are now the seat of its
action. Noxious causes of various kinds may
disturb this natural process, in which case the in-
creased vitality rushes back to the uterus or to
the peritoneum still in an irritable state, causes a
violent action of the blood-vessels and inflamma-
tion, which now that the blood is impregnated
with nutritious matter, has a great tendency sud-
denly to deposit it by secretion ; hence the fre-
quent inundation of an incredible quantity of a
caseous or milky fluid mixed with much water in
the cavity of the abdomen, chest, or even the
brain and extremities. To prevent by any means
this tendency to effusion, is the object of our art ;
it is the consequence of inflammation which often
suppresses the other secretions, particularly the
lochia, hence a modified antiphlogistic treatment,
so as to prevent the above exudation (with a re-
ference to the character of the then prevailing
disea.ses) is, in these complaints where nature can
L 3
n 114 ;]
do nothing for herself, of the most beneficial con-
sequence. Hippocrates was acquainted with this
most dangerous disease, but ascribed it always to
the suppression of the lochia, which, however, is
for the most part a consequence of it ; he gives
an accurate description of it in the first book De
Morbis mulierum. Cap. 60, 6.3, 66, et 69.
The cases of this year were uncommonly mild,
and often scarcely to be called puerperal fevers,
and they yielded to a simple mild treatment. This
disease, however, is often characterized by extreme
violence and great mortality, to whfch the reign-
ing epidemic gi'eatly conduces ; the best directed
means are not then always able to prevent its as-
suming a dangerous form. The following were
the cases treated in the hospital : —
FEBRIS PUERPEEALIS LEVIOR.
Elizabeth W. nineteen years old, a maid-ser-
vant, was, on the 23d of December, safely deli-
vered of a healthy child, she lost a good deal of
blood. On the 24th, without apparent cause,
there came on headache, vertigo, sparkling of the
eyes, ringing in the ears, shivering and heat, with
pains in the abdomen. She was admitted into
the hospital on the 2Sth, with pain in the head,
the breasts were swollen and hard, the abdomen
distended, and painful to the touch, particularly
towards the left ileum; the lochia flowed copiously,
the pulse was frequent, contracted, and somewhat
hard- Emollient cataplasms were applied to the
belly and similar glysters injected, and in order to
derive the milk from the breasts she took Potass,
sulph. et Roob. Samb. ex Dec. Alth ; warm
cloths were applied to the breasts. Moderate
C 115 ]
evacuations by stool took place, the belly sub-
sided, the milk came away partially from the
breasts, the fever abated, and she felt herself so
much better, as to desire her discharge, to be
employed as a wet nurse ; she left the hospital
cured on the 5th of February. This case was an
incipient puerperal fever, the development of
which may often be fortunately prevented by a
simple mode of treatment.
A second case of a maid-servant, thirty years
of age, and who was delivered on the 30th of
May, was equally fortunate. On the fourth day
after parturition, a shivering with subsequent heat
and darting pain in the abdomen, but more parti-
cularly near the pubes came on ; she could not
bear pressure on the part. When admitted on
the 4th of June, the head was oppressed and
painful, the tongue dry, the breathing free, the
breasts full of milk, the abdomen somewhat dis-
tended, and not suffering pressure near the pubes;
the lochia flowed, the stools were regular, the
heat of the body increased, the pulse moderately
quick, tense, and somewhat hard. Decoct. Alth.
mannat, and emollient cataplasms were ordered.
On the 5th, the headache was much diminished,
the breasts still tumid with milk, the abdomen was
after four evacuations almost entirely reduced,
and the pain insignificant. The milk was taken
from the breasts by means of glasses for that pur-
pose ; it came in part spontaneously away. Dur-
ing the following days, her recovery advanced
uniformly, and with mere attention to her regimen
she left the hospital on the 8th of the month.
The third case was that of a maid-servant,
twenty-three years old, who was delivered on the
8th of December ; there was a wrong presentation
i: 116 3
and tedious labour ; in a few hours after delivery,
shivering, heat, and headache came on. On the
10th, she came into the clinical hospital ; the pain
in the head was violent, the tongue white, no milk
in the breasts, the belly enlarged, the hypogas-
trium throughout very sensible to the touch, and
pressure thereon gave acute pain ; the heat of the
body was moderately increased, the bowels cos-
tive, the lochia suppressed, the urine dark red,
the pulse frequent, small, and somewhat hard.
Ten large leeches were applied to the belly, emol-
lient poultices and glysters were employed, and
Decoct. Althasae mannat. ordered. On the 11th,
the headache had abated, the thirst was still
great, the tension of the abdomen diminished, the
inflammation seemed now to affect the left ovary,
near which she could bear no pressure, the urine
deposited a mucous sediment, the lochia returned
during the night, she had a moderate alnne eva-
cuation, the pulse was moderately frequent, some-
what tense. Six leeches were repeated to the
seat of pain, and Mistur. Amygd. given for her
di’ink. On the 12th, she was much better, the
abdomen was soft, the pain greatly diminished,
there was sediment in the urine, and abundance
of lochia. Her amendment now proceeded, the
pain disappeared, the lochia became natural, the
breasts were filled with milk, the secretion of
which was encouraged, as the patient was desir-
ous of becoming a wet-nurse. On the 19th of
December she was discharged cured.
DYSENTERY.
This disease during many years had seldom
been observed in this place ; this year it was only
sporadic, and during the months of June and July,
C 117 3
which were cool and moist, the nights were
uncommonly cold, and gave rise to numerous
diarrhoeas.
The dysentery for the most part came on as
diarrhoea, which when neglected, became attended
with shivering and feverish symptoms, tenesmus,
and tormina, when but little faeces came away :
if this was also neglected, the stools became
bloody, the fever increased in violence, and a ge-
nuine Enteritis was formed, when instead of fre-
quent stools, no alvine excretion took place.
The treatment of dysentery is always to be
guided by the character of the fever ; at the same
time we must bear in mind that a more or less in^
flammatory state of the intestines is always pre-
sent: mild, mucilaginous, soothing remedies, as
salep. Althaea, Acacia, and emulsions, answer the
best ; or should gastric impurities be evident,
Gramen. Manna, Ammonise murias. Ipecacuanha ;
and afterwards Caliimba, Cascarilla, Cinnamomum,
emollient cataplasms, and mucilaginous glysters,
(in small quantity and often repeated) form an es-
sential part of the treatment ; where a true inflam-
matory character prevails, leeches to the rectum,
or even to the surface of the abdomen, are indi-
cated: if the tormina still continue after the in-
flammatory tendency is overcome, opium is the
best remedy : a strict regimen and carefully avoid-
ing cold, are of the greatest consequence.
With this treatment, the cases which occurred
this year were cured in from eight to fourteen
days. The following case was treated in the cli-
nical ward : —
DYSENTERIA INFLAMMATORIA.
Josepha Daubrawa, a maid-servant, eighteen
c: 118 3
years old, having enjoyed constant good health till
in her seventeenth year, she was seized with a
violent nervous fever, and from which time her
menses had disappeared, was attacked with a dull
pain in the abdomen (attended with shivering),
which, according to her description, extended to-
wards the anus. In the evening she had seven
loose evacuations, and frequent griping, which was
soon followed by an inclination to stool, by which
generally little was evacuated ; this was attended
with a burning feel about the anus. These sjunp-
toms increased daily ; some streaks of blood ap-
peared in the evacuations, and at length nothing
but blood came away.
On the 14th of July the patient came under our
care. She complained of headache, loss of appe-
tite, her tongue was white, the abdomen tender
to the touch, more particularly under the right
flank, in the course of the ascending colon ; she
had had, during the day, several stools attended
with griping and tenesmus ; the heat of the skin
was increased, the pulse feverish. Ordered, Rad.
Salep 3j ; coq. ad dissolut. Col. adde Mu-
cilag. Acac ; Syrup. Papav. aa ^ss. six leeches to
the abdomen, and emollient cataplasms.
On the 15th, the urine deposited a branny sedi-
ment, and diaphoresis came on ; the abdomen
continued painful, and she could not bear pres-
sure ; the leeches were repeated, and the other
remedies continued : towards evening a bleeding
from the nose took place, and she was, as far as
regarded the headache, much relieved.
On the 16th she was much better; the stools
were less frequent, as well as the griping and pain.
During the night the menses re-appeared. Nothing
was changed in the treatment till the 20th, when
c: 119 :i
merely Decoct. Alth. simp, was ordered, with which
she recovered entirely.
INFLAMMATIONS OF THE JOINTS.
Rheumatism and gout are among the most
common diseases to which mankind are subject:
they are equally frequent both in their acute and
chronic form ; the symptoms of both are very ana-
logous, whence all pains of the limbs are by the
ancients called arthritic. Tralles thought that the
term rheumatismus was not used by them, and
that Ballonius first introduced it into medical use ;
however, we find this expression in Pliny, Coelius
Aurelianus, and Alexander Trallian. Even the
great Boerhaave makes no mention of rheumatism
in the two first editions of his Aphorisms, but
treats of it in the three later ones. Ludwig,
R. A. Vogel, and Stork, make scarcely any dis-
tinction between these diseases. One must, in
fact, grant that from the very similar appearance
of them, it is often impossible at the patient’s bed-
side immediately to determine whether he has
rheumatism or gout ; and fortunately this does not
make any important difference in the treatment,
which is very similar in both. Yet Sydenham
(Sect. vi. Cap. 5,) says, “ morbus hie (rheumatis-
mus) quoties a febre sejungitur. Arthritis saepe
audit, quamvis essentialiter ab illS^ distinguatur,
prout cuivis facile constabit, cui uterque morbus
intimius fuerit perspectus; unde forsan petenda
est ratio, cur tarn sicco ilium pede transiverint
scriptures medici.”
Physicians of the present day have almost every
where considered these diseases as distinct, which
indeed is confirmed by experience; since, in a re-
trospect of their causes, development, formation.
i: 120 3
and termination, essential differences doubtless
prevail. With this view, we may properly distin-
guish between Rheumatism, Inflammation' of
THE Joints, and Gout.
Rheumatism consists in irritation, or inflamma-
tion of the fibrous textures covering the muscles,
or of the serous membranes ; which is manifested
by lancinating pains, liable to metastasis ; having
for its principal cause the interrupted cutaneous
secretion, from exposure to cold ; and hence from
the reaction of the skin, the disease is communi-
cated to these textures.
The inflammation of the joints has its seat, as
the name imparts, in the joints ; these consist of
fibrous and serous textures, very much connected
and exercising peculiar offices, which are by in-
flammation either impeded or totally abohshed.
This comes on either like rheumatism after expo-
sure to cold, which more readily affects these
parts not much removed from the surface, or from
mechanical causes, and metastasis of disease; (in
which case the pain is not liable to change its seat,)
or it appears in the shape of specific disease, viz.
the Gout. This disease gradually developes it-
self from inward causes, and from the innermost
recesses of our organization; it is grounded in de-
ranged action of the digestive organs, especially of
the hepatic system, and also in an unnatural ad-
mixture of the blood, which does not secrete a
chalky matter (phosphate of lime) in sufficient
quantity by the kidneys, it manifests itself by de-
rangement of various kinds, more especially by
periodical attacks of lancinating pains in the joints.
Hence the inflammation of the joints in the gout
is not the essence of the disease, but only the form ;
a symptom by which nature, through a morbidly
c 121 ;]
increased action of the capillary blood-vessels en-
deavours to separate this chalky matter, and for
this purpose she calls into action the secretory or-
gans as well as the joints. These attacks are,
therefore, true critical efforts, by which, through
the continued perspiration, the copious sediment
in the urine, sometimes by intestinal evacuation,
as also by the separation of phosphate of lime on
the synovial membranes. Nature endeavours to
ameliorate the crasis of the blood. This morbid
crasis of the blood a]>pears to be brought about
by disorders of the digestive functions, which is
indicated as well by the remote causes of gout,
as by its connexion with many other diseases
widely differing from it in their symptoms ; these
are especially new and acid wines and luxuri-
ous living, or the continued use of hard viscid
nutriment ; hence the frequent appearance of this
disease among the lower classes (for it is quite con-
trary to experience to hold that it is incident only
to the higher ranks of life): debility of digestion,
from various excesses in regimen, continued de-
pressing affections of the mind, as care and bad
health, whose powerful influence on the liver is
well known ; further, immoderate exertions of the
mind, a sedentary life, especially with too nutri-
tious diet, continued suppression of perspiration,
or the repelling of cutaneous affections. If we
consider all these different causes, it will appear
that they effect a derangement of the digestive
functions, either idiopathically or through sympa-
thy of the viscera, and an unnatural crasis of the
blood.
When once predisposition to gout is developed
in the body its attacks are easily produced, and
often in an aggravated form by the slightest
M
c: 122 :
causes ; errors in diet, and atmospheric changes
especially conduce to this effect ; if the imperfect
crasis of the blood (as Dr. Kreysig from good
reasons asserts,) be the chief cause of goub we
may the more easily account for its close affinity
with haemorrhoids, stone, and liver complaints;
also for the hereditary predisposition ; its metas-
tatic nature may depend on the excited state of
the capillaries, which cannot prevail with equal
violence at the same time through the whole sys-
tem, but now affects one, then another part of it.
Moreover, the near connexion of the gout with
diseases of the heart may be explained by this
view of the subject, whilst the coats of the blood-
vessels are, like those of the joints, by excitement
of the capillaries disposed to inflammatory action.
The difference between gout and rheumatism ap-
peal’s evident from this statement. In the latter,
those symptoms of derangement in the digestion,
and of unnatural admixture of the blood, are
wanting: it is not hereditary, it presupposes in-
deed a disposition, but not that inward slowly de-
veloped, continued tendency, the diathesis arthri-
tica, which is not removed by the paroxysm, and
which in gout can scarcely if ever be eradicated.
The recurrence of rheumatism is accidental,
and for the most part connected with external
causes ; gout is a periodic disease of persons ad-
vanced in life, and the return of its paroxysms
depends on its own nature. With respect to the
treatment, these diseases, especially when they
are acute, very much agree ; both consist in an
inflammatory state, which, according to the degree
of acuteness, is inflammatory irritation, or true in-
flammation ; hence an antiphlogistic treatment,
with a particular regard to the exhalant function
: 123 3
of the skin, best corresponds with the indications ;
yet we must not be led astray by too great atten-
tion to the last object, and forcing a diaphoresis
with remedies for that purpose ; it comes on of it-
self during the appropriate treatment of the fever,
and the attempt to force it only increases that
symptom with the pain and inflammation, and pro-
longs the complaint.
In mild cases, quiet and moderate warmth, the
removal of currents of air, by the application of
equally warm and dry clothing enveloping the
parts, mild infusions, small doses of nitre, muriate
of ammonia, and elder roob are advisable, till a
crisis takes place.
In violent cases, where actual inflammation comes
on, blood-letting is indispensible. If the pain is
very violent and fixed, the swelling hard and burn-
ing hot, the fever acute, the pulse full and hard,
(in sanguineous habits especially) bleeding cannot
be omitted, as also when any vital oi’gan is attacked
with it. Otherwise, inflammation of the joints does
not in general require venesection, and it becomes
necessary more from the state of the fever than
the local suffering ; and w'here the former is not
violent, nor carries with it a genuine inflammatory
character, bleeding does not effect much good,
but rather tends to prolong the disease. But to-
pical bleeding by leeches (and when the great sen-
sibility of the skin does not prevent), by cupping
with scarification, is so much the more indispen-
sible, which last are very beneficial by removing
the increased irritation of the surface. As the in-
flammation of the joints often runs a tedious course
of some weeks, these topical bleedings must be
repeated according to circumstances. Whenever
the pain by its great violence indicates an increase
c 124 ;]
of the local inflammation, we are by no means to
delay the repetition of their use. When the vio-
lence of the fever is abated, should the local suf-
fering remain in spite of the diminished redness
and tension of the part, blisters or sinapisms in
its vicinity, or rubbing in mercurial ointment, or
that made with the tartrate of antimony, has a be-
neficial effect; so also inwardly. Liquor Ammon,
acetat ; Vin. antimon. Flores Sambuci, Dulca-
mara, Calomel, Sulphur sublim. et Antim. tarta-
rizatum.
This affection does not bear moist warmth, yet
where there is genuine inflammation, the pain vio-
lent, and the tension great, emollient cataplasms
must be employed, but only continued whilst there
is an urgent necessity for them. Enveloping the
part with warm tow, flannel, and sear cloth, pro-
duces very desirable effects, by keeping up an
equable perspii’ation. We are likewise to take
care, that not only the skin but the other secreting
organs are kept in action; hence mild laxative re-
medies, as Gramen, Potass, tartras, et supertartras,
Sodae vel Potassae sulphas, in moderate doses,
have such good effects, and at the same time cor-
respond with the deranged state of the primae viae,
which is so often present. WHien the inflamma-
tion is removed, and a more chronic state prevails,
Aconitum, Antim. sulph. praec ; Calomel, Guaia-
cum, the warm bath, and the use of irritating ap-
plications, as Liniment. Ammonia?, vel Camphorje
comp, are indicated. The cases of the present
year were altogether of a milder character, though
in some years inflammations of the joints occur
frequently and with great acuteness. A few cases
follow •
i: 125 D
ARTHRITIS ACUTA.
Thereza Zebritzkin, a charwoman, forty-five
years old, had been for some time subject to pains
in her limbs, but was for months free from them,
when she could take care of herself. On this oc-
casion, her complaint was brought on by exposure
to a current of air, from which she immediately
felt a violent pain in her left shoulder, and could
not in consequence move the arm. On the 4th of
February she came into the clinical hospital. The
shoulder joint was somewhat swollen, very painful
to the touch, the febrile symptoms moderate. She
was ordered Decoct. Althaeae cum Roob Sambuci,
and the part to be enveloped with tow, as also to
keep her bed. She fell into a profuse sweat, and
the pains disappeared. On the 22d she was quite
free from complaints, and was discharged.
A somewhat more violent case occurred in Jo-
seph Siegel, a police officer, who, in his laborious
office, was exposed to the severity of the weather,
and was seized with violent pains in his right knee,
so that he could not walk : he was admitted on
the sixth day from the attack. He had consider-
able fever, complained of pain in the head, loss of
appetite, the right knee was swollen, hot and pain-
ful ; he could not bend the knee, nor move the
foot without violent pain. Ordered, four large
leeches to the knee, the joint to be enveloped with
dry tow ; inwardly, Dec. Alth. cum Potass, nitrat.
et Roob Sambuci; at night he perspired freely,
and during the day the skin kept moist, and he
found his knee much better; the swelling had also
greatly diminished. By the continued use of these
remedies, and perfect quiet, the patient lost his
complaint, the urine deposited an abundant sedi-
M 3
c: 126 :
ment, his appetite returned, and in a few days he
was cured.
ARTHRITIS CHRONICA.
A man, thirty-six years old, came on the 11th
of April into the hospital, with violent pains in
the right hip and knee-joints. He considered it
the consequence of a suppressed gonorrhoea; at
all events, the pains came on soon after the stop-
page of the discharge, and had tormented him
during eight months ; he was free from fever, and
the appetite w'as good. He was ordered a powder,
consisting of extract of Aconite and Calomel, each
half a grain, to be taken thrice a day, and for his
drink, a decoction of burdock root. The pains
diminished in the first week, but became again
worse; he could not walk or move the parts with-
out difficulty and pain. Unguent. Hydrargyri was
ordered to be rubbed in, and to continue the other
remedies.
On the 24th, symptoms of ptyalism appeared,
the pains were much milder; the mercurial re-
medies were now discontinued. On the 26th, the
ptyalism w'as very great, his gums, tongue and
cheeks were very much swollen, and from the
constant flow of the saliva, and pain in the mouth,
he could take no food. The right parotid was
much enlarged, even taking his soup caused great
suffering, and fever came on ; but all his pains in
the joints had disappeared. He had emollient
gargles ordered, and the following, Dec. Gramin.
5viij. Potass. Sulphat. 5ij ; Koob Sambuci, 5®s.
On the oOth, the salivation still continued in
the same degree, for which powders, with two
grains of Sulph. sublim. were given every three
hours, and a blister applied to the neck. The
c: 127 ]
symptoms of ptyalism now decreased, but in pro-
portion as this lessened, the pains of his joints re-
turned. He had now ordered. Inf. Stipit. Dulca-
mar. ex 5y- parat. Liq. Ammon, acetat. 3hj 5
Sacch. pur. 5ij ; and a blister in the shape of a
garter under the knee. His complaints became
stationary, and he suffered from the slightest
change in the weather. A decoction of Guaiacuni
was now substituted for that of the dulcamara ;
half an ounce of the wood was used, and the Liq.
x-kmmon. acet. added ; the mercurial ointment was
again had recourse to. His pains were now greatly
relieved, he perspired freely. A grain of Ant.
tart, was added to the decoction, and emollient
baths with soap, and afterwards with aromatic
herbs were employed. With this treatment, the
patient was in nine weeks freed from his com-
plaints ; he accustomed himself by degrees to the
air, and has since enjoyed good health.
ISCHIAS PEDIS SINISTRI.
Anna Livin, a weakly girl, twelve years old, was,
after exposure to cold, seized with pains in the
left hip-joint, which extended to the thigh and
knee. When she came into the hospital, on the
Sd of April, the integuments about the great tro-
chanter were swollen and painful to the touch; the
heat of the skin increased. Ordered, six cupping
glasses with scarification to the hip-joint affected.
Internally, Dec. Alth. cum Potass, nit. et Roob
Sambuci. On the following day the pains had
greatly diminished, and she was already able to
move the limb. On the 5th, a blister was applied
to the hip-joint, and as the pain in it was not en-
tirely removed, a perpetual blister to the great
trochanter, and Plummer’s powder were ordered.
C 128 ;]
She was relieved, though the pain did not entirely
disappear ; she perceived it more particularly on
moving her foot ; the use of mercurial ointment,
and every second day a warm bath was ordered ;
the ointment was soon discontinued from salivation
having appeared, and for which she took a grain
of Sulph. Sublim. every two hours. The ptyalism
was removed, and with it the rest of her pains, and
she was discharged cured on the 28th of May.
EXANTHEMATA.
Erysipelas.
This year was very productive of exanthematous
diseases ; erysipelatous inflammations were nume-
rous, especially of the face, to which females were
particularly liable. Exposure to cold, or indul-
gence in fat meats were generally considered as
causes. Six cases came into the hospital, five of
which were cured and one died.
The treatment was in the outset antiphlogistic,
with a particular regard to keeping the body open,
which was effected by the use of neutral salts.
Baglivi rightly says, “ alvus stricta semper exacer-
bat capitis morbos;” and in another place, “ Erysi-
pelate Faciei laborantes vidi brevi curatos post
praescriptum purgans remedium aegri naturas ac-
comodatum.” When the fever became moderate
and the inflammatory state was subdued, mild
diaphoretic remedies were next employed ; the
topical applications to erysipelas consisted of dry
warmth, which at the beginning was effected by
the application of light cloths, and then later,
with sacks of elder and chamomile flowers; if these
aromatics were applied at the beginning, or if, as
is not uncommon, the part was rubbed over with
[ 129 ;]
camphor, they could not be endured by the patient
from the burning pain and increased heat which
they occasioned. Still more pernicious is that
method, (prevalent with the common people) of
applying white lead, or an ointment made with it,
to erysipelas of the face. It is sufficient that the
access of the air be }>revented by a light covering.
Should the head be much affected, and the fever
violent, leeches must be applied to the head and
blisters to remote parts ; bleeding is only to be
employed in urgent cases, and with great circum-
spection ; it is always in this disease a doubtful
remedy, for erysipelatous inflammations bear it
with difficulty. Derangement of the primag viae,
of the liver and its functions, are causes of erysi-
pelas, the latter ai’e know'n by yellowness of the
tongue and countenance, by tension and weight at
the praecordia. In this case, antibilious remedies,
such as Potass, tart, et Supertart. Vin. antim.
Tamarindi, and when there is a tendency to eva-
cuate upwards, emetics also may be employed.
ERYSIPELAS FACIEI PUSTULOSUM.
John W. twenty-eight years old, fell sick on the
26th of November, 1822, without assignable cause,
and came on the 29th, into the general hospital ;
he had violent pains in the forehead, dosed fre-
quently, but without rambling ; the whole of his
face was swollen and very red, in the middle of
which blisters rose, filled with lymph, attended
w'ith great pain and tension. The eye-lids were
quite closed, the tongue dry, the urine pale red,
with a slimy sediment ; the heat of the skin in-
creased, the pulse equal, full, and soft; he took.
Decoct. Alth. with half a drachm of nitre, two
drachms of Glauber’s salt, and half an ounce of
c; 130 3
elder Roob, the face was covered with a dry
cloth.
On the 30th of November, the fever abated,
but he had had no stool, for which a glyster was
ordei’ed. December 1st, the patient felt pain in
swallowing ; on examination the external glands of
the neck were found enlarged, to which warm
cloths were also applied. December 3d, the
fever and erysipelas had almost disappeared, the
skin scaled off; and on the 6th, all morbid ap-
pearances were gone. On the 1 1th, he went home
cured.
A second case of a milder kind was the follow-
ing
Margaret Petzkowa, a maid-servant, twenty-
four years old, was on the 5th of January, after
exposure to cold, attacked with fever, and at the
same time, a burning sensation of the face. On
the 8th she came into the general hospital.
On the left side of the face, a shining pale red
erysipelatous inflammation presented itself ; the
fever was not violent. Ordered, Dec. Alth.
Potass, nit. Potass. Sulphat. aa ^ij ; Roob Sam-
buci, 5ss. warm cloths to the face. The disease
went on mildly. On the 13th, the urine sepa-
rated ; she complained still of stupor and heaviness
of the head ; the pulse was moderately quick and
free. As in the treatment of erysipelas, a parti-
cular attention to the brain is requisite, a blister
was applied to the neck, and half a grain of
calomel given twice a day ; the pains of the head
now disappeared, as well ns the erysipelas. As
she was of a costive habit, the following was
ordered ; Dec. Graminis jviij ; Oxymel, 5ss. On
the 16th, the pains in the head returned, for
which a blister was applied between the shoulders.
She had numerous loose evacuations, and a perfect
recovery was eifected. On the 28th, she went
home cured.
ERYSIPELAS FACIEI GRAVIORIS NOT^.
A bad case happened in the person of Anna
Klaudin, a woman in her forty-eighth year. She
was, on the 14th of December, 1822, taken with
shivering and subsequent heat, followed by tension,
burning, redness and swelling of the face, so that
she could not open her eye-lids. She complained
on her admission (the sixth day of the disease) of
headache, vertigo and tinnitus ; the fever was vio-
lent, she had had no stool for five days. Six leeches
were applied behind the ears, sinapisms to the
calves of the legs, and dry warm cloths to the
face. Inwardly, Dec. Alth. Pot nitrat. 5j-
Potass, sulph. 5iij ; Roob Sambuci, 5ss. A glyster
with salt. By the continued use of this remedy,
the fever abated, as also the swelling of the face,
which scaled off; the urine separated, so that on
the 1st of January all the symptoms had nearly
disappeared, and the mixture was discontinued.
But from an imprudent exposure to cold, the ery-
sipelas appeared to be coming again in the face.
Mild remedies to evacuate the bowels and pro-
mote diaphoresis, as Dec. Graminis, cum Sodse.
sulph. et Roob Sambuci, and warm cloths re-
newed to the part, prevented its breaking out. On
the 18th, she was quite recovered, and went home
to her family cured.
ERYSIPELAS FACIEI MORTE TERMINATUM.
The fatal case happened to a charwoman, forty-
one years of age, who, after a difficult parturition,
got from a violent fright an erysipelas of the head.
c: 132 ;]
for which, after a fortnight, she sought relief at
the hospital. Her face was covered with scabs,
the head heavy, the eyes sparkling, the tongue
coated, the bowels relaxed, the pulse frequent,
small and oppressed. Leeches were repeatedly
applied to the head ; blisters, sinapisms, and gentle
diaphoretic remedies employed ; and as the fever
assumed the nervous type, Flores Arnicas with
camphor were administered. She appeared in
fact to be getting better, when unfortunately some
wine was brought her by her friends ; after taking
which, a violent pain soon came on with great
stupor and affection of the chest. Notwithstand-
ing the application of leeches, and an urgently
indicated small venesection of only three ounces,
the use of emollient and afterwards slightly cam-
phorated remedies, a fresh eruption took place,
and death followed on the 15th of February, the
twenty-fifth day of her illness. On opening the
cranium the vessels of the dura mater were
found turgid with blood, on cutting through which
the surface of the brain on both sides of the
longitudinal sinus was covered with lymphatic
exudation ; a considerable quantity of serum was
found in both the lateral ventricles, and at the
basis cranii. On opening the thorax, the right
lung was found attached firmly to the pleura cos-
talis ; the lungs were deficient of blood and soft.
In the abdomen all was natural. This patient
consequently died of apoplexy from a repressed
erysipelas, and to which the pernicious use of the
wine had chiefly contributed.
THE MEASLES.
The measles prevailed in this year as the only
widely extended epidemic, they began to shew
c: 133 n
themselves sporadically in the winter months, but
soon spread themselves and raged with uncom-
mon violence and extent, especially in the months
of March, April, May, and June, and they gra-
dually disappeared in the months of July and
August. In general, this epidemic Avas not ma-
lignant, and not to be compared, as to the danger,
with the scarlet fever of 1822. Still, in the great
number ol those attacked many very serious cases
occurred. They attacked children chiefly, and
proved fatal to many of them by the accession of
violent inflammation, particularly in the trachea
and bronchia, (angina membranacea and bronchi-
tis) as also by their repercussion, or passing into
the putrid state. Their attack was always at-
tended with catarrhal symptoms. If a child was
seized with a bad cough, it behoved the physician
to be on his guard against the probably consecu-
tive measles. This cough lasted for some days,
with coryza, a flow of tears, and sneezing ; the
children were restless, got no sleep, and within
three or four days, (sometimes much later) feverish
symptoms Avith shivering came on. Often, how-
ever, the fever and catarrhal symptoms appeared
suddenly, AA'ithout any premonitory signs. The
eruption shewed itself generally after the second
or third paroxysm, first on the face and breast,
then on the extremities and the rest of the body.
They complained of pains in the head, the tongue
had a white coat, the appetite went, the thirst was
great, the cough violent, generally dry, but a true
peripneumonia or bronchitis, Avith difficulty of
breathing, oppression of the chest, inability to
fetch a deep inspiration, very teazing cough, rest-
lessness and anxiety, readily came on. The bowels
were generally costive, though towards the end of
N
c: 134. 3
the disease there was a particular tendency to di-
arrhoea. However, diarrhoeas sometimes preceded
and the catarrhal symptoms followed. The bleed-
ing from the nose, stated by von Wichmann as a
pathognomonic symptom, was in this epidemic
seldom present, and the peculiar sweet smell, like
the feathers plucked from a living goose, men-
tioned by von Heim, was not observed. The
eruption appeared as solitary deep red spots, some-
what more pale in their circumference, the size of
a lentil, with a small knot in the middle, raised
above the skin ; the spots soon multiplied, so that
a general redness occupied the surface, which had
then a marbled appearance ; the cough remained
obstinate through all the stages of the disease, and
was often attended with inflammatory affections
of the larynx and trachea (a true angina). Fre-
quently ophthalmia took place, which, without
any particular attention, passed off; at most it
was only necessary to avoid the light. Though
this disease in many cases was mild, and when left
to itself terminated favourably, with the efforts of
Nature, still it often happened that many patients
were lost from neglect. When it observed a re-
gular course the eruption began to disappear about
the sixth day ; branny scales followed, and with
these all the attending morbid symptoms disap-
peared ; the cough was the last to give way. Di-
arrhoea came on in many cases, and exhausted the
strength of these little ones. Often from the be-
ginning, but generally in the convalescence, a
quinsey took place, so that perhaps there never
was a better opportunity of observing this disease.
Not imfrequently in the inflammatory affections of
the chest there was a great tendency to serous ef-
fusions, and hydrops pectoris, or even general ana-
Z 135 ]
sarca were the consequence. If the child was get-
ting its teeth, the disease became more complicated,
and inflammatory affections of the head were ob-
served, inflammation of the brain and subsequent
convulsions, which soon proved fatal. Even adults
were not spared by this disease, but it was not in
them attended with such danger (which was by no
means the case with the scarlet fever of 1822),
so that no unfavourable instance occurred. In vio-
lent affections of the lungs, the state of the chest
required diligent attention, otherwise continued
coughs, and even consumption, were the conse-
quence. The treatment was in general simple,
and moderately antiphlogistic ; it was especially
desirable not to do mischief by a too active prac-
tice. It was in general sufficient, with a rather
observant sort of treatment, to give Decoct. Alth.
with a little Flor. Papav. Rhaead. or Verbasci, and
mild drinks of an infusion of mallows, or a decoc-
tion of barley with liquorice root. If the heat was
great, the skin dry and hot, a few grains of nitre
were of great benefit ; external irritation, and si-
napisms to the legs wei'e employed as revellents
with good effect. Diarrhoea was best opposed by
mucilaginous soothing remedies, with which inten-
tion salep root, and small doses of ipecacuanha
proved excellent ; with this view Dover’s powder
could rarely be employed. Local mischief, espe-
cially of the chest, required leeches, and the cy-
nanche the most energetic antiphlogistic treatment,
else suffocation took place. With regard to the
regimen, a moderately warm temperature, roomy,
dry apartments, and cleanliness, conduced much
towards a happy result. Seven cases of measles,
chiefly grown up persons, were received into the
clinical hospital, who all did well, and of which
some cases follow: —
[ 136 3
MORBILLI CUM DIARRHCEA.
Karl Raholiska, twenty-one years old, a law
skiflfeht, was on the 7th of Januar}' seized with
shivering, and subsequent continued heat ; on the
8th coryza came on, wdiich increased, with fre-
quent sneezing. On the 9th he had pain in the
eyelids; on the 10th, pain in the forehead, with
some cough ; in the evening he remarked that his
face was full of red spots ; he still went abroad.
As on the 11th these spread, he came on the 12th
into the hospital. The symptoms were headache,
burning and oppressive pain in the eyes, the ves-
sels of the conjunctiva developed, a tickling of the
nose, and obstinate catarrh ; the whole body co-
vered with the eruption, the tongue white, thirst,
violent dry cough, yet without pain of the chest ;
considerable fever and diarrhoea (seven stools this
day), the pulse frequent, full, and soft. Ordered,
Rad. Salep. 3j ; coque ad Solut. Colat. adde
Sacch.pur. 5ij ; R Pulv. rad. Ipecac, gr. ij ; Sacch.
pur. 5j. m. f. pulv. div. in dos. sex; one to be taken
every three hours; Mistura Corn, usti for his drink.
On the following day fifteen grains of muriate of
ammonia were added to his mixture ; in other
respects he was the same, he had had two liquid
stools. On the 15th, the eighth day of the disease,
were observed marks of desquamation ; the purg-
ing was less violent. On the 16th the urine threw
down a branny sediment ; the appetite returned,
the cough w'as less violent, the powders were
given less frequently. The amendment thus be-
gun, w-as not again interrupted ; and on the 22d
the desquamation w'as ended. On the 2-lth he re-
turned to his studies.
i: 137 3
MOamLLl CUM AFFECTIOXE FAUCIUM ET LARYNGIS.
John Wanick, a student, thirteen years old, of
a robust habit, was on the 2^d of February (the
sixth day of his illness), brought into the hospital,
his face and body swollen with the eruption of
measles, a slight ophthalmy and catarrh, with
coryza, stoppage in the nose, and pain in swallow-
ing ; the inner fauces were slightly inflamed, he
had a dry cough, with constant irritation, the
urine pale red, the pulse quick, full, and soft.
Ordered, Decoct. A 1th. cum Pot. nit, et Syr. Alth.
On the 23d, he had not slept during the night,
the cough was very troublesome, he had hoarse-
ness and tension in the throat, to which emollient
cataplasms were applied, and his other remedies
continued. On the 24th, his nose began to dis-
charge, the irritation of the mucous membranes
still continued, and he complained of a tickling in
the larynx. The nitre was omitted, two leeches
were applied to the larynx, and powders with one-
third of a grain of calomel given. He became
better, the eruption was for the most part scaling
off, and he perspired. Decoct. Alth. mannat.
was given for a costiveness of some days, the
cough and tickling disappeared, and he was free
from complaint ; he was discharged cured on the
8th of March.
The measles had a very mild course in a boy,
six years old, who came on the 1st of April into
the clinical hospital, quite covered with eruption ;
the fever was pretty strong, the heat of the skin
much increased, and he had a dry hard cough.
Decoct. Alth, cum Pot. nit. et Roob Sambuci
was ordered. With the use of this remedy the
fever abated, the eruption disappeared, a desqua-
N 3
C 138 3
mation of the cuticle took place, the cough ceased,
and on the 13th he left the hospital quite well.
MORBILLI IN SURDO-MUTA.
Franziska Dorfel, eleven years old, deaf and
dumb, came on the 11th of April, 1823, into the
clinical ward. She made signs of having head-
ache and pain in swallowing, the tonsils and uvula,
as also the conjunctiva were red and inflamed, the
eyes were affected with the light, and the tears
flowed ; a hard dry cough troubled her, the skin
was very hot, and full of the measles, the urine
very high coloured, the bowels costive, the pulse
frequent and somewhat hard. Ordered, Dec.
Alth. cum Pot. nit. et Syr. Sambuci, an emollient
gargle, glysters, and seclusion from the light. On
the 16th, the eruption was at the height, the
thirst very great, the pulse beating pretty strong.
From the 17 th to the 19th the symptoms were
much the same, only the thirst diminished, and the
skin was no longer so hot, the eruption disap-
peared, and the skin began to desquamate, the
urine threw down a reddish sediment. On the
20th, the measles, the inflammatory irritation of
the eyes, of the throat and breast had disappear-
ed ; the medicine was discontinued, and on the
21st she went home cured.
SCARLET FEVER.
The epidemic scarlatina of 1822, the treatment
of which in the general hospital of this place was
exemplified by cases in the treatise above men-
tioned, ceased in the month of November. In
this season for the clinical school, only one case
presented itself, but it was tedious.
I 139 3
SCARLATINA MACULOSA.
John Peschata, sixteen years old, an appren-
tice, of a scrofulous habit, was seized on the 18th
of November with headache and considerable
heat ; on the 1 9th, pains in the throat came on,
followed by enlargement of the tonsils, and much
difficulty of swallowing. On the 20th, he had an
itching over his whole body, with great thirst. On
the 21st he was received into the clinical ward.
Pain in the head, sparkling eyes, animated look,
and thirst ; the tonsils and velum pendulum very
much enlarged and inflamed, deglutition very
difficult, the tongue white, the whole body cover-
ed with the scarlet eruption ; he had many loose
stools, the pulse was very frequent, small, and
tense. Ordered, Decoct. Salep. Mucilag.
Acac. 5ss. Sacch. pur. 3ij. four leeches to the neck,
an emollient gargle and cataplasm. On the fol-
lowing day, as the symptoms had not diminished,
the leeches were repeated, and sinapisms applied
to the legs, to cause a greater revulsion from the
head. During the course of his fever he had
twice bleeding at the nose, and on the 27th, des-
quamation took place, and the fever was termi-
nated by critical sweat and urine. On the follow-
ing day, a considerable tumour of the glands of
the neck came on but without fever ; half a grain
of calomel was given three times a day, and emol-
lient cataplasms applied : it, however, suppurated,
burst, and left a hardened state of the surround-
ing parts. This was at last reduced by mercurial
friction, and emollient poultices with hemlock ;
the abscess closed by degrees, and after several
weeks he was discharged.
: 140 ]
CONTAGIOUS TYPHUS.
How the typhus fever took its rise this year
has been before mentioned ; the atmospheric
changes from snow storms to wet weather in April,
contributed thereto ; and they also produced here
and there in the city nervous and putrid fevers.
At the beginning the typhus appeared in a two-
fold manner ; as gastric bilious, and as catarrhal
fever ; the former was accompanied by dulness,
and a yellowish redness of the eyes, the tongue
had a thick yellow coat, there was fruitless incli-
nation to vomit, tightness in the region of the
liver, with frequent mucous or watery stools ; the
latter by a dull headache, abhorrence of light,
the conjunctiva bloodshot, coryza, cough, and
slight pneumonic symptoms. It began wdth shi-
vering, and subsequent heat, the head became
affected ; great stupor was a constant symptom ;
the countenance was flushed, and had a particular
cast of indifference or stupidity, the look pecu-
liarly changed, the eyes as if half closed in sleep,
or twinkling; the speech hasty and stammering, or
slow and heavy, the hands trembling ; wandering
soon came on, from which in the beginning they
were able to recover themselves, and w’hen ques-
tioned, to consider and give an answer, but after-
wards they fell into absolute insensibility. During
the night they were most restless, wandering
throughout, attempting to get up, and often only
to be restrained by a strait waistcoat. Towards
morning a copious perspiration took place ; the skin
was, indeed, always found in a perspiring state, a
circumstance wdiich in general does not attend this
disease ; the pulse generally very frequent, full,
and somewhat hard ; within no determinate time.
[ 141 ]
though commonly from the fourth to the sixth
day the peculiar eruption took place ; it had the
greatest resemblance to that of the measles, and
which this year could with great accuracy be as-
certained, as there were many patients who then
had the measles. It was often absolutely not to
be distinguished from the appearance which they
have six or eight hours after their eruption, if the
manner of it, the violent symptoms of the head,
the stupor, and the less marked complaints of the
chest, as also the less frequent occurrence of
measles in adults, had not assisted in forming the
diagnosis. For which reasons the name exan-
thema morbilliforme typhosum, may be considered
as forming its characteristic.
It consisted in red spots scarcely raised above
the skin, of various shapes, often long or oval, of
the size of millet seed, which did not disappear
from pressure \vith the finger. It was most evident
on the breast and forearms, and in a few cases
extended over the whole body ; it disappeared in
two or three days without any evident desqua-
mation or other change in the skin. But the
disease pursued its course, which extended to the
14th, 17th, 21st, or 25th day, and in many cases
still longer.
All those who had bleeding at the nose or mode-
rate diarrhoea, recovered more easily. No sooner
w’ere the bowels constipated, than the delirium
became more violent. It was only in a few cases
this year, that a nervous state, with absolute debi-
lity, a sinking and really weak pulse, and the
other symptoms of diminished strength were ob-
served ; but the disease went on with stupor and
heaviness of the head, generally a dry tongue,
though the skin was inclined to perspire: the
C 142 3
pulse was full, or weak and oppressed. The
urine was of a dull red colour without sediment,
till the 14-17th day. It then, with an exacerbation
of the fever, threw down a sediment, copious per-
spiration came on, and the period of recovery took
place. The cerebral affection readily put on an
inflammatory character, and not unfrequently also
inflammation attacked the chest, with some, symp-
toms of pharyngitis appeared, and these were (as
in 1813,) in spite of all the means used, fatal cases.
The red or white miliary eruption was equally
pernicious ; this appeared on the 9th, 1 1 th, 13th, or
16th day, with symptoms of violent oppression of
the chest, continued some days, without any re-
markable change of the disease ; often suddenly
disappeared, when great anxiety, delirium, spasms
and convulsions came on, which were soon fol-
lowed by the death of the patient. Petechiae
shewed themselves generally on the 6th, 11th, or
14th day, sometimes with the miliary eruption in the
same person, and in some few cases they appeared
with the characteristic typhus exanthema, soon
disappeared, and had no influence on the disease,
either for better or worse. In one case, which,
however, terminated favourably, black streaks (vi-
bices) were observed. The mode of treatment was
determined by the character of the fever ; a rather
observant than active practice was employed,
though in the catarrhal cases, this was rather of
the antiphlogistic kind, and where bilious symptoms
prevailed, of the mild antigastric. Emetics w’ere
scarcely admissible from the violent affection of
the head and inflammatory tendency in the brain,
lest by their action, the humours should be urged
thither with greater vehemence, and the less so, as
many of the patients had used them before they
C 113 ;]
were brought to the hospital. — In delirium, the
head was kept cool ; when violent, cold applications
to it, leeches and cupping on the neck were em-
ployed with great advantage. Irritation of the
skin, especially blistering, was of great use in a
more advanced stage of the disease. Emollient
remedies, as Salep, Althaea, according to circum-
stances with nitre or muriate of Ammonia in the
catarrhal cases ; mildly opening remedies, as Gra-
men, Tamarindi et Ammoniae mur. in the bilious
ones were given in the outset ; in the course of
the disease, where there were no urgent symptoms,
the object was rather to support the powers of
life. Camphor, and especially stimulating reme-
dies were seldom used, as the vital powers were
rather oppressed than deficient, there being too a
prevailing tendency of blood to the brain, and also
an almost constantly perspiring state of the skin.
On the contrary,- the oxygenated muriatic acid,
which they took willingly from its mild and not
unpleasant taste, was in many cases used with
good effect. This, acid, which combines the ad-
vantage of a moderate price, (which for general
hospitals is a matter of consideration) appeared
when given in the quantity of two or three drachms
to an eight ounce mixture, in some cases greatly
to moderate the course of the disease, and per-
haps to contribute to its happy termination, (not-
withstanding the previous bad symptoms) in the
form of a simple though protracted gastric fever.
In this dose it did not confine the bowels, but
rather promoted that excretion without causing di-
arrhoea. When, however, the purging was present
it could not be administered. It was occasionally
mixed with the patient’s drink. If admixture of
the humours, and a putrid tendency came on, Acid.
C Ui ]
sulph. dilut ; Elix. acid. Haller ; Elix. \ itriol.
Mynsicht. were employed wdth success, when a
diarrhoea did not impede their free use.
These diarrhoeas, if moderate, were not of conse-
quence, but when the patient was suddenly seized
with a constant purging, meteorismus and the ex-
haustion of his strength followed. In such case,
the decoction of Salep, Rad. Arnicae. Ipecac, and
in very urgent cases, Extr. Tormentil. from half
a drachm to a drachm, mucilaginous glysters and
aromatic fomentations were very serviceable, they
moderated the diarrhoea without suppressing it.
The tormentil proved itself in this dose an ex-
cellent remedy, and which had also cheapness to
recommend it ; it might with reason be compared
to that valuable medicine, the calumba root.
When nervous symptoms of a spasmodic nature
appeared, as trembling, spasms, and convulsions,
Oxyd. Zinci, and in some cases musk, with all
kinds of irritation to the skin, were employed
with advantage.
In this epidemic, the greatest prudence with re-
gard to blood-letting was required, for it was not
easily borne. Where symptoms ot violent inflam-
mation evidently appeared, and wdiich would not
yield to repeated topical bleeding, it was of neces-
sity employed, but one could only with difficulty
and anxiety determine upon its use. I thus
treated a boy in typhus, wdth violent inflammation
of the lungs, viz. with bleeding and emollient re-
medies ; the violence of the still increasing inflam-
mation, dyspnoea and other symptoms urged us to
a second venesection, but he died on the following
day. Convalescence was in general short ; when
the appetite returned, they soon recruited. By
the encouraged and immediate admission of those
C 145 3
seized with typhus into the general hospital ; by
separating them from the other patients, (as far as
could be effected in a hospital,) by daily ventilation
ot the wards, the most careful attention to cleanli-
ness, and diligent employment of fumigations with
oxygenated muriatic gas, the further spread of
this infectious disease was fortunately stopped in
a month. That typhus, taken by infection in
a hospital is of the most dangerous kind, was un-
fortunately proved by the death of two promising
physicians, who fell victims to its violence.
In the wards of the general hospital there were
faity-nine cases of typhus treated, of which ten
died. Four were taken into the clinical hospital,
the account of whose cases may serve as examples
of our mode of treatment. This is the fifth epide-
rnic typhus which has occurred since I began prac-
tice. The first attracted my notice in 1805, when
a candidate of medicine in the general hospital
at V lenna; the remaining four in 1809, 1813, and
18^J, I treated as physician in different hospitals.
Ihe two first were remarkable for the violence
of their course, by the not unfrequent appearance
of petechim, and that ’of 1809 by the dysentery
which generally accompanied it, (Typhus dysen-
tericus) as well as for the frequent occurrence of
inflamed parotids. In both the diarrhoea, which
could not be moderated formed, the most danger-
ous symptom; by it the patient’s strength was
exhausted, and death was very often the conse-
quence.
The well known direful typhus epidemic of
1813, had in its course a triple stadium, it came on
in the autumnal months with gastric symptoms,
which in the winter changed into the genuine ner-
vous, and with such depression of the vital powers
C 146 ;]
that the most powerfully restorative treatment was
requii’ecl to keep up the quivering flame of life,
till a crisis took place. In the spring of 1814,
its character changed into the catarrhal tjpe,
when it became much milder, and a more soothing
observant practice was adopted. A singular cir-
cumstance attended this epidemic, that though
frequent purging attended it the patient’s safety
did not seem to be thereby endangered. The
two last epidemics had with respect to their origin
a great resemblance, but they were here confined
to the general hospital ; they were remarkable by
the almost constant appearance of the measley
eruption, and also in this, that the nervous stage
was not attended with absolute debility, but rather
a suppression of the nervous energy, from an in-
flammatory irritation of the brain. The last epi-
demic was quite peculiar, in being almost through
its whole course attended with a moist state of the
skin, having at the same time all the other cha-
racters of typhus. The following were the cases
treated in the clinical hospital : —
TYPHUS CONTAGIOSUS LEVIOR.
A young man, twenty-one years of age, of a
sanguineous and robust habit, was taken, without
assignable cause, with lassitude, heaviness in the
head, loss of appetite, and pain at the stomach.
After an emetic prescribed by a physician, and
which operated twice, he had a violent shivering and
subsequent heat, great stupor and some loose stools.
As these symptoms increased daily, he was on the
1 4th of April (the eighth day of his illness) taken
into the clinical hospital. The patient had great
pain in the temples, with considerable stupor ;
his nights were very restless, in which he rambled ;
c: 147 ;]
his countenance was dull and flushed, the eyes
blood-shot, ringing in the ears, the tongue white
and moist, the thirst great, and a trifling cough ;
though the chest as well as the abdomen, except
a sense of pressure at the stomach, were free from
pain ; he had had one loose stool, the pulse was
frequent and soft. An eruption of small red spots
was perceived on the breast, which did not vanish
by pressure, which also, though less evident, was
to be seen on the fore-arms; he was ordered
Decoct. x\lth. cum Ammon, mur. 9j. et Sacch.
purif. On the 15th, the cephalic symptoms con-
tinued, he could not raise himself without vertigo,
the eruption also remained, the urine quite red,
there was a cloud in the middle, the other appear-
ances as before; a blister was applied between
the shoulders. On the 1 6th, the eruption had
disappeared, the cough was somewhat worse, the
urine had a cloudy deposit. On the 17th, he
wandered a little, the ringing in the ears continued,
and he had five loose stools. Powders, with a
quarter of a grain of ipecacuanha, were’given three
times in the day. In this mild state the disease
went on with a uniform but moderate degree of
stupor. On the 20th, (the fourteenth of the dis-
ease) the urine threw down a mucous sediment,
and the cough was attended with an abundant,
thick, grey expectoration, which gave him great
relief. The skin was during the whole disease soft
and moist. The tongue now began to appear
clean, his appetite returned, and all the disordered
functions were gradually restored'; still the ringing
in the ears continued to the 27th of April, the
twenty-first of his illness. He recovered with a
nourishing diet, and was discharged cured on the
Sd of May.
C 148 ]
This ^v^as the mildest case of typhus this year,
and of which there were but few equally so ; the
simple treatment confirms Hildenbrand’s decision
tnat typhus fever scarcely admits of other means
ot cure than the sanative powers of nature, with
clue attention to circumstances.
typhus contagiosus gravior.
D. Wenzel, a youth, eighteen years old, of a
robust habit, was on the 8th of April, without ap-
parent cause, taken with violent cold and subse-
quent heat. An emetic administered gave him little
i^liet, a c 17 cough came on, and the fever continued.
n the 15th, (the seventh day of his illness) he
came into the clinical hospital with the following
symptoms.— Stupor, with a dull pain in the fore-
nead, flushed countenance, great thirst, a deep in-
spiration brought on cough, the breathing in gene-
^ f ^ heat of the skin increased, and
attended w’lth copious perspiration ; the urine high
coloured, the pulse frequent, full, and pretty strong.
Oidered, Dec. Alth. cum Pot. nit. 5ss ; his cough
became milder, though the fever continued ^vith
gi eat heat, and on the 18th, the characteristic ty-
phoid eruption shewed itself on the breast and
upper extremities ; the cerebral afl'ection remained
le same. ec. Alth. cum Acid. mur. oxygenat.
5y- was given, and increased to three drachms :
meanwhile, the stupor, tinnitus, and muttering deli-
rium continued; a blister was applied. On the
.wUtb, the eruption had disappeared, the stupor
muained, the pulse frequent and somewhat sunk.
On the 21st, (the thirteenth of the disease) he had
some loose stools, the head was easier, he had a
general diajihoresis ; the urine pale yellow, with a
oating cloud, the cough w'as more frequent, but
: 149 ;]
less violent. As the bowels became too relaxed,
die oxygenated muriatic acid was laid aside, and
in its stead a scruple of muriate of ammonia em-
ployed. On the 2;2d, consciousness returned, the
patient was lively, the cough somewhat dry, the
skin desirably moist, the urine pale red with a
sediment, the pulse moderately frequent and suffi-
ciently strong. As the cough was troublesome to
him, Dec. Sem. Lini. cum Ext. Hyos. gr. ij. was
ordered, and continued for some days. His con-
valescence soon followed, he regained his former
health, and left the hospital on the 5th of May.
TYPHUS CONTAGIOSUS CUM PERIPNEUMONIA.
Joseph K. eighteen years old, a culprit, was
seized with typhus in the prison, and was on the
23d of April (the sixth of the disease) brought
into the general hospital. Together with the
common symptoms of this disease, as great debi-
lity, dulness of hearing, and a peculiarly troubled
pale countenance, an inflammatory affection of
the brain, more particularly announced itself by
violent headache, bloodshot eyes, intolerance of
light, nightly delirium, and strong pulsation of the
carotids. Phe breast also, on which no eruption
was now visible, was affected, the respiration
hurried, accompanied with a laborious cough,
little expectoration, but a sense of tightness, though
a deep inspiration •was not hindered; the pulse
was very quick, full, and rather hard. Ordered,
six leeches behind the ears, cataplasms to the
chest, sinapisms to the legs, inwardly, emollient
remedies. Early on the 25th, a copious bleeding at
the nose took place, which recurred in the after-
noon, from which the patient was much more
tranquil, but the oppression at the chest as well as
o 3
C 150 ]
the cough continued. Six more leeches were ap-
plied to the chest. On the 26thj he bled again
copiously from the nose. On account of the con-
tinued difficulty of breathing, six cupping-glasses
were applied to the sternum, and inwardly ,°Decoct.
Alth. cum Ext. Glycyrrhiz. 5j. per. Infus- parat; nor
did this give the desired relief, the breathing con-
tinued difficult, the heavy pain under the sternum
as before, and the pulse oppressed and small. For
this, on the 2/th, with reference to the reigning
epidemic, which did not admit of bleeding in ge-
neral, from the urgency of the occasion, he was
bled to three ounces, and went on with the emolli-
ent remedies and cataplasms ; the chest became
more free, the oppressive pain gave way, but the
bleeding seemed to occasion the disease to pass
into the nervous state ; vertigo and tinnitus came
on, the head was affected with stupor, the tongue
dry, the eye languid, the pulse weak and quick ;
he also had now a diarrhoea. Blisters were ap-
plied to the legs, and he took Decoct. Salep. spiss.
^viij. Extr. Calumba? 3j ; with powders contain-
ing Ipecac, gr. ss. e%'ery three hours. He con-
tinued many days in the same state ; the inflam-
matory affection of the chest frequently recurred,
and was remedied by leeches and blisters. The
disease was terminated by a copious puriform
expectoration, which often comes on after typhus.
One might easily be led to consider this as
consumption, though it occurs but seldom after
this disease, at least when the pulmonic symptoms
have not been neglected ; the lungs seem in this
case to have introduced a genuine depuratory
process. By degrees, he took Decoct. Polygah
amar. and Inf. Rad. Caryophyllat, and afterwards
Decoct. Lichenis,with Inf. Summit. Cent, minor. —
c: 151 ;]
He only recovered gradually, and required more
than two months before he was quite well.
TYPHUS CONTAGIOSUS CUM PETECHIIS.
A culprit, thirty-three years of age, and mode-
rately strong habit of body, was on the 11th of
April (the seventh day of his illness, which began
w ith shivering and subsequent heat, and continued
with catarrhal symptoms, as heaviness of the head,
stoppage of the nose, flushed eyes and cough)
brought in the following state into the general
hospital : —
The head was oppressed with stupor, there
was tinnitus and dulness of hearing, the coun-
tenance swollen and flushed, with a peculiar mark
of stupidity, the eyes red and sparkling, and
something very strange in his look, the tongue
much coated with a white mucus, the thirst great,
a moderate cough, the breathing free, the abdo-
men somewhat swollen, but soft, the pulse fre-
quent, full, and tolerably strong. There was no
tiace of exanthematous eruption, it might pro-
bably have already disappeared. Decoct. Gram,
^m Ammon, mur. 9j. and sinapisms to the legs.
Delirium came on during the night, in other res-
pects he continued the same ; four leeches were
applied behind the ears, and at night a blister be-
tween the shoulders. On the 13th, tw^o mild eva-
cuations follow'ed, and there appeared on the
breast and fore-arms many violet and black pe-
techiae ; the stupor and muttering delirium conti-
nued, the pulse was frequent and sufficiently
strong. Cold applications were now used to the
head, and sinapisms applied to the thighs. On
the Tlth, a pretty copious haemorrhage from the
nose took place, from which the head was in
C 152 3
some measure relieved, but the abdomen became
swollen, without accompanying pain, copious di-
arrhoea came on, the pulse was equal, frequent,
and tolerably strong. Together with mucilagi-
nous glysters to moderate the purging, there was
ordered. Decoct. Salep. spiss. ^viij. Extr. Tor-
mentillae 5ss. aq. cinnamom ^ss. and aromatic fo-
mentations to the abdomen. This state conti-
nued without much variation the two following
days, yet the evacuations were less frequent, and
the abdomen had subsided. On the 17th, the
head was less affected, he was not so deaf, and
consciousness had returned, yet the urine re-
mained as it had been throughout, of a dark red
colour. During this improved state a crisis took
place on the 23d, with profuse sweat and sedi-
ment in the urine, which lasted four days ; the
arid mucous membranes relaxed, and secreted
abundance of mucus during the convalescence,
which was supported by Dec. Cinchonge.
TYPHUS CONTAGIOSUS PUTRIDUS CUM PHARYNGl-
TIDE.
The following is one of the most serious forms
in which this fever appeared : — Marcus Sch— —
twenty-five years old, a student m surgery, very
diligent, and in needy circumstances, exhausted
with loss of sleep and continued application, was
admitted on the 10th of April (the fifth of his ill-
ness,) and which he ascribed to bad diet, with
the following symptoms : —
The head ached and was heavy, the tongue
had a white coat, no nausea, the abdomen tender
in the epigastric region, the stools regular, the
pulse quick, full, and weak. Dec. Gram, cum
Ammon, mur. and for a drink Dec. Hord. cum
c: 153 ;]
Acido tartarico were ordered. On the 13th the
patient was remarked to have a peculiar stupid
look, he lay indifferent to all that passed, answer-
ed with difficulty, questions put to him, the face
and skin of his body had a livid sooty appear-
ance, especially about the nostrils and ears ; the
eyes were dull and surrounded with a blue ring ;
the lips and tongue dry, covered with a black
paste, the hands trembled, the characteristic
typhoid eruption now first appeared, and in
two days went away. To these symptoms was
added a general yellow and somewhat black
look, which gave him a horrid appearance; hesi-
tation and loss of speech followed, with partial
paralysis of the tongue and muscles of degluti-
tion. He was not able to keep any liquid in his
mouth, still less to swallow it ; the mouth itself
distorted ; he had spasms of some of the facial
muscles, and strabismus, also pain in the course
of the oesophagus, and a sense of suffocation ; de-
lirium came on with the desire to quit his bed,
then coma, subsultus, and finally a total immo-
bility of the body, with a cadaverous smell ; with
which appearances, after uncommonly violent
though unconscious suffering, and after the fruit-
less application of every means, death took place
on the 22(1.
In the course of the disease leeches were applied
to the neck, cold applications to the head, repeated
blisters and sinapisms, mercurial inunction to the
neck, emollient soothing remedies, then oxyd. zinci
cum Calomelane, Rad. Arnicae Liq. Ammon, subc.
Castoreum, Moschus, Balsam Vita? Hoffmanni,
stimulating glysters and aromatic lotions were em-
ployed. The body had on the following day
C 154 3
become so putrid, that no examination of it could
take place.
INTERMITTENT FEVERS,
Intermittent fevers were seen in 1813, and be-
fore that time pretty frequently in Prague ; they
have on the contrary, during the last ten years,
from unknown causes, very rarely occurred. In
the present year, however, they were somewhat
more frequent, still only sporadic, and in general
very mild. With regard to the type. Tertians
and Quotidians are the most frequent ; I have
not found here in Prague the opinion established,
that genuine quotidians are extremely rare, (such
being as Platei’, Fernelius, Senac, Riverius, and
Mercurialis hold, only double tertians) for in the
double tertian, the paroxysms of the equal and
those of the unequal days correspond as to the
time of their attack and acuteness, whilst the real
quotidians come daily at the same hour and in the
same degree. There are, notwithstanding, here
and there double tertians.
As regards the treatment, they are almost
always removed by neutral salts, particularly mu-
riate of ammonia ; where there is gastric impurity,
combined with small doses of Ant. Tartariz. Tarax-
acum, afterwards with Rad. Caryophyllat. Flor.
Anthem, and bitter remedies ; and when these do
not succeed, after five, seven, or nine paroxysms,
by small doses of Peruvian bark.
Ten years ago emetics were very beneficial, at
present, on the contrary, the indications for their
use are not so commonly present. It is wor-
thy of remark, that notwithstanding the rarity of
intermittent fevers, still in each year some ap-
peared in the masked form of violent headache
C 155 ]
(febris intermittens cephalalgica). They were
often not easily made out, though their periodic
attack, a slight trace of shivering with subse-
quent heat, and their obstinate resistance to the
remedies employed, led to their diagnosis. They
were cured by that excellent remedy the Peru-
vian bai'k.
FEBRIS INTERMITTENS QUOTIDIANA.
Joseph Berger, a servant, twenty-six years old,
of a robust habit, exposed himself to the cold in
the middle of January, 1823, and got an intermit-
tent fever, which attacked him daily at the same
hour. This soon disappeared by the use of some
remedies prescribed by a physician, but from
some error in diet it returned, for which, on the
29th of January, became into the clinical hospital.
He had cough, and the tongue was coated, but
no other morbid symptoms except those of the
paroxysms. For the first five days, he took Dec.
Alth. cum Ammon, mur ; afterwards Dec. Tarax-
aci with the same salt ; and lastly. Inf. Anthem,
cum Extr. Menyanth. 3ij. The paroxysms di-
minished under this treatment, he had lastly only
warnings of a somewhat increased heat, and these
soon disappeared.
On the lOth of February he had quite reco-
vered ; he left the hospital with renewed appetite
and good digestion. This case of a quotidian
proved mild, and was cured without its being ne-
cessary to have recourse to the Peruvian bark.
A quotidian in a coachman, twenty- four years
old, which had continued six weeks, gave way to
the use of Decoct. Gram, et Taraxaci cum Pot.
Tart, and Pulv. Anth. fl. gr. vj ; Ammon, mur.
C 156 ;]
gr. iij. A proof how easily sometimes, in sound
habits, intermittents may be cured.
FEBRIS INTERMITTENS TERTIANA PROTRACTA.
John T. thirty-seven years old, a criminal, after
taking some fat meat, had oppression at the sto-
mach and loathing of his food. After some time
he experienced a violent coldness with subsequent
heat and sweat. These attacks recurred on the
third day, at the same hour, whilst at other times
he found himself better. After fourteen weeks
in this state, he came on the 22d of March 1823,
into the hospital. He had a cachectic look, was
pale and bloated, he had a bitter taste, his appe-
tite was good, could not bear pressure on the
liver, stools natural. Ordered, Rad. Tarax. R.
Saponar. aa ^j. f. Dec. Colat. ^viij. adde Ammon,
mur. 5ss. To this was added afterwards Ext.
Anthem. As he complained of tightness at the
chest, and had moreover a cough, a blister was
applied to the sternum, which appeased these
symptoms. The paroxyms diminished both in
duration and violence. He next took Inf. Rad.
Caryoph. cum Ammon, mur. et Ext. Anthem, and
afterwards the following, Aq. jNIenth. jR- Cin-
chonas 5ij. Zingiber, cont. 5ss. sumat. Coch.
unum secundi qu^ue horii, Phial4 agitatS^. On
the 15th of April, the bark was given in decoction,
by the use of which the paroxysms entirely dis-
appeared, and his look improved. On the 2Sth,
he took for a diarrhoea, Aq. Menth. jiv. Ext. Ca-
lumb. 3j. On the 6th of May, he complained of
violent pains in the shoulders and arms ; he had
given him powders of Ext. Aconit. gr.ss. ter die,
and blisters a])plied to both the arms. On the 9th,
he took a grain of tartar emetic in chamomile tea.
C 157 ;]
By the 17th, he had lost all his complaints; had
a healthy look, good digestion, and was discharged
on the 23d of the month.
FEBRIS INTERMITTENS LARVATA CEPHALALGICA
POST PLEURITIDEM.
A singular case of remittent fever occurred in a
stout young man, a distiller’s apprentice, named
Christopher Tdgel, who was admitted on the 19th
of June. By exposure to cold he had brought on
a pleurisy, which by bleeding, leeches, &c. was re-
moved. He had still some degree of pungent pain
in the chest; suddenly at four in the afternoon he
was seized ivith violent shivering, subsequent heat
and sweating, attended with such intolerable pul-
sating headache, as to give reason to fear an in-
flammation of the brain might came on ; his face
was swollen and flushed, his eyes sensible to the
light, bis pulse beat forcibly, as did the carotids.
He went on with the use of antiphlogistic reme-
dies which he had before used, and six leeches
were applied behind the ears. On the following
day he was better, scarcely any fever, but nearly
at the same time as on the preceding one, his fe-
ver returned in like manner, with still more vio-
lent headache, so that eight leeches were deemed
necessary, and applied : there was no longer any
doubt of its being a febris intermittens quotidiana
comitata, which threatened on the next paroxysm
the greatest danger, and hence required immedi-
ate relief. Cinchona was given in some of its de-
coction ; he had another violent paroxysm, during
which the bark was omitted, and four leeches
were applied ; after which the decoction Avas re-
sumed (half an ounce of the bark to eight ounces
of decoction), and in addition two drachms of the
p
c: 158 n
powder were added. The folio wng paroxysm
was milder, half a drachm of ginger was now
added to the mixture, with the intent of suppress-
ing the next attack. It in fact did not return,
but at the same hour he felt great lassitude, the
other symptoms disappeared. Except a debility
in walking, he felt quite well, longed for food, and,
after a fortnight’s residence to guard against a re-
lapse, he went home cured.
In the above case the violence of the parox-
ysms, and the danger of apoplexy being the con-
sequence, required the most energetic practice
for their removal. The antiphlogistic treatment
was urgently required during the attack, but if
continued, would have been prejudicial as a mask-
ed intermittent fever was the real cause ; hence
the cure depended on a right employment of the
Peruvian bark.
CHRONIC DISEASES.
Hcemorrhagies.
Haemorrhagies belong to those diseases which
require the immediate exertion of our art. The
menacing danger renders necessary a decisive
mode of ti’eatment, and the timidity of the patient
calls for an encouraging and soothing demeanour.
The structure of the part affected and the occa-
sional cause of the disease render its treatment
various, and any thing but uniform in all cases.
The most frequent of them, and at all times re-
quiring immediate relief, are especially hgemor-
rhagies from the lungs and womb.
Ilccmoptoii.
This happens in general between the ages of
fifteen and thirty-six ; a predisposition to this dis-
: 159 3
ease is grounded on the natural formation of the
body ; where there is a long neck, shoulders wing-
like, and projecting forwards, a narrow flat chest,
and a circumscribed florid complexion ; also when
in early youth the nose was apt to bleed, and
suddenly stopped at the period of manhood, such
persons are liable to hsemorrhage from the lungs,
if they are not so fortunate as to suffer from the
haemorrhoids. Among the most frequent occasion-
al causes are exposure to severe cold, especially
the cold bath, when the body is heated, running
fast, violent dancing, anger, immoderate exertion
of the chest in crying, singing, or blowing of wind
instruments ; excess in spirituous drinks, irregu-
larities in the haemorrhoids or menses ; and me-
chanical injuries to the chest. Haemoptysis, also,
happens as a symptom in inflammations of the
lungs, in consumption, in affections of the heart
or great blood-vessels, from constipation of the
bowels, and putrid or scorbutic crasis of the
blood. The treatment has, for its object, first
the yet possible removal of the cause. Should
this, however, as is usual, be no longer in our
power, we must next distinguish between active
and passive haemorrhage, in the former we must
begin with blood-letting, which is the only remedy,
and not to be replaced by any other.
The usually full and hard pulse, the suddennes^s
of the attack, and the presence of florid frothy
blood are urgent considerations to adopt this with
due energy, especially in plethoric habits; but also
the small and apparently weak pulse, the pale
countenance and cold extremities, which are com-
monly the effects of fear, should not deter us from
its use ; the pulse rises often on its adoption, and
becomes full and hard. It is only contra-indi-
C 100 3
cated by great debility, or in a person exhausted
by excess, or protracted anxiety of mind, or where
there is absolute torpor and debility of the lungs.
As often as a fresh attack of haemorrhage takes
place, whilst there is still oppression at the breast
with a tense and hard pulse, the repetition of
blood-letting is called for, a too great precaution
may in this case be very dangerous, and may
cause either immediate death, or subsequent
phthisis.
We must employ inwardly those remedies which
are most mild, cooling and mucilaginous, as Al-
thma, Emulsions, Gum Arabic and cooling drinks,
to which small doses of nitre may he added when
the evacuated blood shews great tenacity ; but if
notwithstanding blood-letting and the other re-
medies, the bloody expectoration continues, and
the pulse seems not to allow of greater depletion,
the time is now come gradually to adopt another
course. The best means now to be gradually
applied are sinapisms, dry cupping in distant
parts, and leeches to the breast or even to the
anus, as revellents ; inwardly, the gradual admi-
nistration of Symphytum, Alumen, Acid. Tartar ;
and where there is spasm, Ext. Hyos. cum Ipe-
cac. in small doses ; where there is great irrita-
tion and a frequent pulse. Acid, sulph. dilut ;
Elix. acid Halleri, Digitalis ; lastly, cold embro-
cations to the chest ; in using which we must
always take care not thereby to increase the
cough, they are indicated when want of contrac-
tion in the extremities of the pulmonary vessels
seems to keep up the hoemorrhage. When, how-
ever, after repeated attacks the pulse rises and
remains hard, we must not desist from bleeding,
C 161 D
nor can any number of times be assigned for its
repetition.
Should all those means prove ineffectual, and
by renewed attacks the system become exhausted,
and a fatal issue seem probable, I have found the
most desirable effect from dried common salt
taken in powder, a tea-spoonful at a time ; the
bloody expectoration almost immediately ceased,
nor was the cough or nausea increased ; the un-
pleasant burning of the throat from its exhibition
was removed by drinking after it some mucilagi-
nous liquor. Perfect quietude of the body, calm-
ness of the mind, a cool temperature, silence, the
removal of all tight clothing, and the necessary at-
tention to the bowels, must be added to the above
treatment.
HLEMORRHAGIA PULMONUM.
A female rope-dancer, eighteen years old, other-
wise of a sound habit of body, with delicate skin
and blood-vessels, on the 30th of December, 1822,
fell into a violent passion, after which she felt a
sense of ebullition in the chest, and a tickling in
the trachea, which excited cough ; she soon began
to bring up florid frothy blood, which came away
in such quantity, as in a short time to amount to
some pounds. She was bled before her admission
to the hospital, which took place on the 1st of
nuary : the bloody expectoration continued, though
not in any quantity ; she had a constant inclina-
tion to cough, and a tightness with oppression and
pungent pain in the left side, which was increased
by a deep inspiration. The tongue was dry, the
belly free from pain and soft, the urine natural,
the bowels regular, the external heat increased,
the pulse moderately frequent, oppressed, and
p 3
c: 162 3
small. She was bled again to six ounces,' and
took Emuls. gummos. with almond milk for her
drink. On the following day, as the cough and
previcus pain continued, six leeches were applied
to the left side, which gave her considerable re-
lief ; the expectoration had now only here and
there a speck of blood.
On the 7th, this irritable person, in a dispute,
fell again into a violent passion, on which the
whole of the former symptoms returned ; she
coughed up, in considerable quantity, florid frothy
blood; the oppressive pain in the chest returned;
the pulse was very frequent, and somewhat hard.
She was bled again to eight ounces, sinapisms were
applied to the legs ; with her former medicine she
took one-third of a grain of Extract. Hyosc. in a
powder, and as much ipecacuanha was given with
a mild emulsion. The haemoptysis again ceased,
the symptoms disappeared by degrees, and her
recovery, during which she merely took Decoct.
Salep. was not again interrupted. She left the
establishment on the 15th of January cured.
H.EMORRHAGIA UTERI.
Htemorrhage from the womb is an occurrence
as frequent as it is dangerous, and which often re-
quires immediate relief. The causes of this hae-
morrhage are very difierent, according as it may
happen to the unimpregnated uterus, during ges-
tation, at child-birth, or during the flow of the
lochia ; hence a quite different mode of treatment
is required in these different circumstances. In
the unimpregnated state, we must often consider
tliis haemorrhage as a diseased menstruation, which
through increased irritability, or torpor of this
organ, is either too early, too abundant, or vicari-
C 163 3
ous of its cessation in the climacteric years. It
also frequently depends on organic mischief, as
schirrus, cancer, polypi, molee, &c., in which cases
it generally appears as a chronic haemorrhage.
During pregnancy, it takes place either as the
consequence of continued menstruation, or the too
early separation of the membranes, or of the pla-
centa, which may be either in its proper place,
the fundus, or upon the os uteri, by which abor-
tion and premature labour are brought about.
During child-birth, it arises from a too early,
partial, or general separation of the placenta, sel-
dom from rupture of the umbilical chord, or of
the uterus. After that event, these haemorrhagies
are generally very violent and often dangerous.
They arise, 1st, from the presence of foreign bo-
dies in the uterus, which prevent its contraction ;
as the placenta or any part of it, the membranes,
detached parts of the foetus and moles ; 2d, from
debility and inactivity of the womb, which arise
from immoderate distention, by difficult labour
with instruments or turning, incautious separation
of the after-birth, as also from a languid habit of
body ; 3d, from spasms ; 4th, from irritating
causes, which ux*ge an excessive flow of blood to
the uterus, as too great heat, too warm covering,
heating medicines, spirituous drinks, spicy food,
violent affections of the mind ; 5th, from inversion
of the uterus.
During the first week after child-birtli, the same
irritating causes often occasion a later haemorrhage
by exposure to cold, a too generous diet, passions
of the mind, &c., the too early quitting bed, or
refusal to give suck. According to these various
causes, an entirely different mode of treatment
must be adopted, and which will always have in
c: 164 ;]
view the removal of them as its first and chief ob-
ject, If, however, the cause can be no longer
influenced, the haemorrhage must, according to
the state of the patient’s strength, be treated as
active or passive. The former requires an anti-
phlogistic treatment, to be regulated by circum-
stances, which in a full habit, and with a full hard
pulse and inflammatory febrile state, may even re-
quire blood-letting. The other remedies are emul-
sions with nitre, cream of tartar, tamarinds, acid,
tartaric, or lemonade, with a low diet, cool tem-
perature, and light covering.
In the months when abortion and premature la-
bour usually take place, the tendency to miscar-
riage should be prevented. This often depends
on a great irritability of the vascular system in
general, and of the uterus in particular, which
comes on at a certain state of its distention, and
shews itself by small haemorrhagies with painful
contraction of the womb, especially in women who
have copious menses; by such, more blood is eva-
cuated by the menses than the foetus requires for
its support during gestation. Whence in such cir-
cumstances, cooling remedies, and even repeated
small blood-lettings, are often useful to prevent
abortion. But when after a due employment of
the above stated antiphlogistic method, the hae-
morrhage still continues, other means must be
employed ; with this view, where the irritability is
great,' Elixir Acid. Halleri, Acid, sulph. dil. and
Digitalis; where there are spasms, Ipecacuan;
where the nervous system is aflfected, as in hys-
teric subjects, Pulv. Ipecac, comp, or opium itself
is indicated. Should the hasmorrhage incline to
the passive character. Alum, Kino, and also sti-
mulants proportioned to the exhausted strength
c: 165 :
are to be employed ; among these, preparations of
cinnamon are preferred for their specific quality.
W here there is total exhaustion, which comes on
sometimes with great rapidity, attended with a
death-like paleness, dim eyes, extinction of the
voice, icy coldness, extremely weak, and often
scarcely perceptible pulse, and fainting, relief is
only to be sought for in the most powerfully re-
storative treatment, as with Tinct. Cinnamom.
Spt. yEth. sulph. Tinct. Opii, wine and bark. The
external treatment is of equal importance, and this
also entirely depends on the occasional causes, the
removal of which by manual assistance, when indi-
cated, often at once puts a stop to the disease.
WTien we can no longer act upon the causes, in
the more mild cases of hmmorrhage, the above
stated diet and regimen will generally suffice.
In cases where the haemorrhage is so violent as
to endanger the immediate loss of life, cold appli-
cations are, (with a due regard to circumstances)
to be applied to the pudendum and abdomen ;
yet this powerful remedy requires on many ac-
counts great precaution, as it cannot be denied
that it produces noxious effects, especially in lying-
in women, by its chilling them, suppressing the
lochia, and bringing on rigor and spasms. The
employment of cold in haemorrhagies is more
especially indicated when the irritable state of the
blood-vessels is removed, and the bleeding de-
pends on relaxation of the orifices of the capil-
lary arteries, from w’ant of their contractile energy.
This diminished contractile power happens more
frequently in lying-in women than in others, and
the danger from haemorrhage is here so great,
that we cannot absolutely dispense with this re-
medy ; still we are to endeavour first to bring
C 166 3
about the contraction of the womb by gentle fric-
tion and pressure of the abdomen. But if urged
to employ it, we still find that it does not succeed,
then injections of cold Avater, alone, or with alum
dissolved in it, or mixed with a little vinegar, or
plugs of linen steeped therein and introduced into
the vagina, are to be employed ; and lastly, when
all these fail, and the complete inability of the
uterus to contract is the cause, the introduction
of the hand, first bathed in cold vinegar and water,
is the last resource of our art. Should, however,
the above described state of exhaustion be attended
with coldness of the body, fainting, &c., then ex-
ternal exciting remedies, as aromatic fomentations
to the abdomen, spirituous embrocations with
aether. Spirit. Saponis*; Spt. camphorat ; et Spt.
aromaticusf are to be used, by which, and the
inward use of similar remedies, the almost extin-
guished life is often fortunately preserved.
H.EMORRHAGIA UTERI IN GRAVIDA.
A maid-servant, twenty-eight years old, four
months gone with child, after a violent fright, was
seized with spasmodic pains in the loins and
thighs ; she at the same time had an appearance
of blood from the vagina. On the following day
the pains were extremely violent, and there ap-
peared some clots of blood ; on the third day, by
the use of some remedy the pains were diminished,
but the haemorrhage continued, for which she
came on the 23d of January, (the tenth day of
* R Sap. veil, gvj ; Pot. siibcarb. jj; Alcobolis thiss. Aq.
lavaiid. ttiss. digere et filtra.
+ R Melissa; recent, tbij ; Cort. Citri. recent. No. x ; Rad.
Angelica; C. Cinn. iiii ^iij ; Coriand. S. Jvj ; Alcohol, ttixj. Aqua;,
pur. tbvj ; inacera et distillent in Balneo Aqua; Ibx.
C 167 3
her illness) into the hospital. The head was free
from pain, the countenance somewhat pale, her
thii’st moderate, the tongue clean, the breathing
good; the pulse was quick, spasmodically con-
tracted, and rather hard ; she could not bear pres-
sure on the hypogastric region, the blood flowed
pretty freely, one could distinguish the enlarged
uterus. She had no stool for three days. She
was ordered to be kept quiet in bed, and Decoct.
Althsege cum Extr. Hyosc. gr. ij. and emollient
glysters were prescinbed. As no evacuation fol-
lowed ; Decoct. Alth. mannat. was given, which
procured some moderate stools. For the haemor-
rhage, she now took a third of a grain of ipecacuan
every three hours, and as her costiveness returned.
Decoct. Gram, cum Magnes. sulph. By a strict
diet, and the above treatment, the haemorrhage
ceased, the pains were removed, and after twelve
days she returned, without suffering abortion, in
good health to her home.
H^MORRHAGIA UTERI POST PARTUM VEHEMEN-
TISSIMA.
A young woman, twenty-one years old, and of
a pretty strong habit of body, was delivered on
the 3d of February of a healthy child, after a
tedious labour ; she lost much blood during the
labour, and the after-birth remained behind. An
accoucheur was called in, who detached a portion
of it, but a considerable part was left attached
to the uterus. An alarming flooding immediately
took place, which could only be repressed with
great difficulty and the employment of cold appli-
cations. But as the cause was not removed, it
returned with renewed violence ; she lost streams
of blood, became of a deadly paleness, cold and
C 168 -2
faint ; and in this dangerous state she was brought
in the evening to the hospital. She was pale, the
eyes dim, there was frequent fainting and insensi-
bility, the colour of the lips gone, the voice low
and scarcely perceptible, no pulsation at the heart
or wrist, the face and hands cold, the uterus dis-
tended, and feeling like a ball through the bed-
clothes ; the haemorrhage went on with such
violence, that she might be said to welter in her
blood. In this state of complete exhaustion from
loss of blood, nothing could be hoped, but from
a treatment which should instantly, as it were, re-
kindle the extinguished flame of life. The re-
moval of the cause (the separation of the remainder
of the placenta) could not be thought of till she
had recovered from this state, as in doing it a
trifling loss of blood must have caused immediate
death ; consequently, aromatic fomentation to the
abdomen, and stimulating odours to the nose, were
ordered; and inwardly, Aq. Menth. Sativ. ^iv ;
iEther. Sulph. 9ij ; Tinct. Cinnam. 5iij ; sumat
Cochleare majus omni quadrante horse, the extre-
mities were rubbed with warm cloths and aroma-
tic spirits, and she had for a drink, as she was
very thirsty, thin almond milk. She came about
in an hour, when a little soup with wine was given,
the bleeding ceased, and she had some sleep during
the night. On the following day she was still in
a state of extreme debility, though consciousness
had returned ; she had not fainted, appeared
more alive, her voice was perceptible, the abdo-
men swollen and painful to the touch, the womb
still distended, the pulse weak, hut perceptible.
To attempt the separation of the remainder of the
placenta became our duty, for without it, a for-
tunate termination could not be looked for; by a
c: 169 ]
gentle introduction of the hand, the remainder was
detached, and with it a considerable quantity of
coagulated blood was evacuated, without any
fresh haemorrhage following. The patient after
a few hours found herself quite revived ; the uterus
contracted, but when pressed, gave pain, the
pulse was fuller and somewhat hard. It was now
of the greatest consequence not to let the previous
debility mislead us by the continuation of stimu-
lating remedies, but to hold in view a possible
inflammation of the uterus, and resolve upon
another, and less stimulating treatment. Emollient
cataplasms were in consequence applied, and the
following ordered ; Mist. Amygd. 5vj ; Extr. Hy-
osc. gr. ij. As the pain continued, in the evening
four leeches were applied to the hypogastrium,
and repeated the day following ; and calomel in
doses of half a grain was given evei’y three hours.
No further haemorrhage appeared, the lochia
flowed regularly, the pain of the uterus ceased,
but a slight cough which she had for some time
had become more troublesome, without however
affecting the respiration ; the breasts became
moderately filled with milk, which disappeared
gradually by the application of dry warm cloths.
She went on with the emollient remedies, and as
the cough continued, a blister was applied to the
breast, by which this became milder, and finally
ceased. During her convalescence, Dec. Cinchon.
et Lichenis was given, which she took for some
days ; but as from accidental exposure to cold,
her cough returned, she was obliged to recur to
the emollient remedies, with which her cure was
completed ; within the month she left the hospital
cured.
Q
C 170 ;]
DISEASES OF THE PRIM.E VI/E.
Diarrhoea.
Diarrhoeas were in this year, as diseases, not
uncommon ; as a symptom in other diseases, they
were as usual very frequent ; they required (as
they were in general of such standing that they
qould not any longer be left to nature,) soothing
and appropriate remedies, as Salep, Mucilag.
Acacias, Rad. Arnicae, Cascarilla, Calumha, Tor-
mentil, Ipecacuan, Pulv. Ipecac, comp. Aq. Cin-
namomi, Myristica, Faba Pichurim, Enemata
Amyli ; very often the most simple means effected
a cure.
A maid-servant came on the 10th of Februarj’,
1823, into the clinical hospital, who four days
before, from a violent fright, was seized with tor-
mina and flatulency, followed by a violent enerva-
ting diarrhoea. The abdomen was collapsed, the
stools were still frequent and watery, she was
without fever, but very much exhausted ; Decoct,
Salep. spiss. ; Extr. Calumb. 3j ; Aquae
Cinnamom. simp. 5ss ; with this simple remedy
she was cured in four days.
A second case, was that of a maid-servant, who
got it by exposure to cold. The abdomen was
somewhat tender to the touch, there was no fever.
The same remedy was given, by which the fre-
quent loose stools were soon stopped. Afterwards
she took, on accountof a cough which’supervened,
the simple salep decoction with Extr. Hyoscyam. ;
this also soon gave way, and she was discharged
cured.
c: 171 ;]
Constipation.
The greatest number of diseases owe their ori-
gin to constipation of the bowels ; of itself this is
seldom considered as a disease, though by many
days continuance, it produces violent colics, and
even incurable inflammations. On the other hand,
we learn from experience, that the most obstinate
cases of costiveness often yield to a mild treatment ;
this, the following case will prove : —
An embroiderer, twenty-six years old, from her
sedentary mode of life, had no stools during nine
days ; various domestic remedies were tried in
vain, she came in consequence on the 23d of April
into the clinical hospital, free from fever ; the
abdomen was hard and tense, and on moderate
pressure she felt a darting pain in the left flank.
She had ordered, emollient glysters, and Decoct.
Gramin. 5viij ; Magnes. sulph. 5j 5 hy which she
had one evacuation, hard, and in small quantity ;
by the continuance of the same remedies during
the following days, several loose evacuations took
place, and, as they were accompanied by griping,
powders with half a grain of the extract of hyos-
cyamus were given, and afterwards her medicine
was changed for Inf. R. Caryophyll. cum Tinct.
Rhei. in order to remove the want of tone in the
intestinal tube, which was in this case the cause
of the obstruction. From the continuance of this
remedy, the alvine excretion became regular, and
after three weeks she left the hospital cured.
DISEASES OF THE LYMPHATIC SYSTEM.
Dropsy.
Next to consumption, the difierent kinds of
dropsy are of chronic diseases, those which most
C 172 ;]
frequently occur in hospitals, and which must
always be considered as belonging to the class of
those w'hich are difficult to cure, being for the
most part the result of protracted disease, and not
unfrequently caused by organic mischief. Their
forms are various, but the most common are the
general dropsy or anasarca, then that of the chest
and abdomen ; their causes are exceedingly
various, yet to remove these, must ever, when
possible, be our chief object. The taking cold
by any means, as by exposure to a current of air,
cold drinks, sudden checking of the perspiration,
&c.; obstructions, repelled eruptions on the skin,
whether chronic or acute, diarrhoeas suddenly
checked, the gout, lowering passions of the mind,
unwholesome damp dwellings, copious evacuations
of blood, and haemorrhagies, the healing of long-
standing ulcers, organic lesion or insidious inflam-
mation of the intestinal tube, scarlatina, suddenly
checked intermittents, debility, and also plethora,
are the most frequent causes. Hydrothorax is
often the consequence of organic disease of the
heart and its appendages, and very often is a com-
panion of confirmed phthisis and other affections
of the lungs ; the difference of the exciting causes
already shews, that the cure of dropsy must be
very various. When the first indication (the re-
moval of the cause) has been attended to, or should
this be no longer in our power, our next object is
to effect the removal of the collected fluid from the
body ; this takes place often by satisfying the first
indication, otherwise we endeavour to effect it by
remedies adapted to the nature of the disease.
Dropsy consists chiefly in the disturbed balance
between the exhalants and absorbents, by which
the absorption is lessened or entirely interrupted ;
C ns ]
this happens when either the motion of the fluids
in the absorbents is retarded by their diminished
energy, or whilst the activity of the exhaling vessels
ill proportion to the absorption is too great, by
which the exhaled vapour is precipitated and
collected in the form of a serous fluid ; hence the
evacuation of the secreted fluids and the preven-
tion of a new accumulation of them become the
chief objects of our art, both of which can only be
effected by acting upon the very various causes of
the disease.
If plethora or an inflammatoi’y diathesis is
present, in which increased tension is the sole
cause of the inactivity of the absorbents, a modi-
fied antiphlogistic treatment is indicated ; here
more especially Potassas supertartras, nitras vel
acetas, and acid drinks, or digitalis and venesec-
tion, according to circumstances, are to be em-
ployed. Bleeding is here truly a most effectual
remedy, but only to be adopted with the greatest
precaution ; it is most useful at the outset of the
disease, when it makes its appearance with acute
symptoms ; such cases occur in the course of in-
flammatory catarrhal diseases, and in inflamma-
tion of the lungs in phlegmatic habits, where
dropsy is frequently the consequence of neglect-
ing venesection when it was necessary.
Topical evacuations of blood are often required
in the febrile cerebral dropsy of children, and in
that which follows Scarlatina. The greater num-
ber of dropsies are unobserved in their outset,
and many of them have causes which would ren-
der venesection inadmissible ; a due regard to the
difference of the causes will decide which reme-
dies are necessary; those that act by the kidneys,
the alimentary canal, or the skin. From much
Q 3
C 174 ]
experience we find, that in general dropsies, the
most efiectual diuretics are Rad. Ononidis et
Levistici, Juniperus, Petroselinum, Potass, super-
tart. vel acetas, Soda, Potassse carbonas, Scilla ;
the last can scarcely be given when there is in-
creased action in the circulating system ; in such
cases digitalis is to be preferred, the most abun-
dant diuresis and proportionate diminution of the
dropsical SM'elling, often follow a small dose of this
remedy, viz. eight to fifteen grains of the dried
leaf, to six ounces of infusion. Should it afifect
the head, or so diminish irritability as greatly to
retard the action of the heart, we must desist
from its use, and if our object is not to reduce the
circulation so much, small doses of camphor, as
two or three grains, added to the infusion, remove
its bad effects and at the same time act benefici-
ally on the skin. Should the suppression of any
cutaneous disease be the cause, then Sambucus,
Dulcamara, Liq. Ammon. Acet., Ipecacuan, An-
tim. tart., Antim. Sulph. prascip., are of signal
efficacy. Calamus Aromaticus, Imperatoria, Ab-
rynthium. Senega, Spirit. Ammon, anisat., and
in obstinate deep-rooted cases. Ext. Lactucae
scariol. and Oxymel Colchici have often excellent
effects.
To excite a counter-action, purgative remedies,
and in great torpor of the intestines the drastic
ones, as Calomel, Jalap, Gratiola, are often effica-
cious. Diuretics fail us in many cases, and should
an exhausting diari’hcea take place, we are obliged
at last to have recourse also to opium; this effect-
ed in some cases not only a stoppage of the above
symptom, but under certain circumstances, had so
desirable an efiect on the urinary and cutaneous
secretions, that its continued use supported the
C 175 ;]
operation of other remedies, and very essentially
contributed to the cure*
HYDROPS UNIVERSALIS EX PERIPNEUMONIA.
John Kara, fifty-five years old, a flax dresser,
much given to drinking spirits, was on the 1st of
August, 1823, brought into the general hospital
in the following state : He was dropsical over his
whole body, pressure with the finger left a pit
which was slow in disappearing; the lower extremi-
ties were particularly hard and swollen, the face
bloated, he could not lie but with the head raised ;
he was most at his ease when kneeling, with his
head and chest bent forwards, and in this posture
he passed the night; he had a dry cough, and
complained of great tightness and pressure at the
chest, breathed with great difficulty, brought up a
saffron coloured viscid mucus, his belly was tense
but wthout apparent fluctuation, the urine turbid
and scanty, the pulse quick, tense, hard, and op-
pressed ; he had been bled before his admission
to the hospital. However much his dropsical
state contra-indicated it, the ui’gent difficulty of
breathing, caused by inflammation, rendered vene-
section necessary, and indeed the only resource,
and four ounces of blood were taken ; emollient
poultices were applied to the breast, Dec. Sem*
Lini cum Potass, acet. 5ij. was given. The blood
formed a slight inflammatory crust, but the pa-
tient found himself much relieved.
On the following day, powders with Digital, et
Hyd. sub. aa gr. ss. ter die, were ordered; and
afterwards Dec. Gram, cum Pot. Acetat. et Oxy-
mel Scillae, and Decoct. Ononid. cum Infus. Gly-
cyrrhiz., changing to Infus. Bacc. Junip. vel Infus.
Petroselini for a drink, and several blisters to the
c 176 n
stei'num, and between the shoulders. In conse*
quence of an abundant flow of urine, the swelling
of his body decreased daily, he had quiet nights,
and could compose himself in any posture. On the
20th of August, he was free from all morbid symp-
toms and was sent home cured, with the advice
never more to indulge in the use of spirits.
HYDROPS EX MORBILLIS.
Maria Kiimlin, seven years old, was brought
by her mother to Prague, in the harvest, after she
had just recovered from the measles. On the
road they were drenched with rain, the child soon
began to cough, to breathe short, and her body
to swell. She was thus admitted on the third day
of her illness, apparently in a dying state. Her
pulse was scarcely perceptible, the hands and feet
cold, the respiration extremely difficult, short,
and anxious ; a deep inspiration was prevented
by pain, the face and eyes swollen, the abdomen
tense and enlarged, there was also diarrhoea.
Four leeches were immediately ordered to the
chest, which it was necessary to repeat ; the day
following, Dec. Salep spiss. cum Saccharo was
given. After the diarrhoea had abated, she had
an infusion of Fol. Digit, gr. viij. in Dec. Salep
jviij. Blisters w'ere laid on the chest, afterwards
Dec. Gramin. cum Potass. Acetat. et Oxym.
Scillae; and lastly, Infus. Rad. Levistici (ex 3ij)
cum Potass, acet. et Qileo-sacch. Juniperi, or-
dered. The breathing became more free ; in pro-
portion as the urine increased, the swelling dimi-
nished ; and in a short time the body lost its
monstrous appearance, and during an abundant
diuresis, returned to its natural state. On the
10th of August, after sixteen days residence in
c: 177 3
the hospital, she was quite recovered, so that she
was able to return home with her mother.
HYDROPS ET ARTHRITIS.
Another case of dropsy, combined with arthritis,
presented itself in a maid-servant, twenty-four
years of age. Some time ago, this patient had
been treated in the hospital for well marked arth-
ritic affections, with swelling of the joints, and
discharged cured. But being exposed to those
noxious causes which not only bring back this
affection, but also produce it, she fell again into
her former state, took no care of herself during a
fortnight ; at last became dropsical, and now re-
turned to the hospital. She had pains in the
joints, sometimes of the upper, at others of the
lower exti’emities, but without fever. She was
much relieved by Infus. B. Junip. et Fol. Dig.
gr. X. cum Spt. AEth. nit ; yet the gout, in the
course of her treatment, occasionally manifested
its inflammatory character in the chest as well as
the joints, for which topical bleeding and blisters,
and inw'ardly emollient remedies with Infus. dul-
camarae, were employed; for her drink. Inf. Juni-
peri ; afterwards, when the fever was abated,
powders with Hyd. sub. ; Ext. Aconit ; et Ant.
sulph. praecip.; the joints affected were kept warm,
and enveloped with tow. By persevering in the
use of these remedies, the patient was not only
cured of the dropsy, but also freed from her arth-
ritic complaints, though it required more than
three months to overcome the obstinacy of this
disease.
Obstructions.
Obstructions of the abdominal viscera, particu-
larly of the liver and system of the Vena Portas,
l: 178 3
are, as the principal cause of hypochondriasis, an
abundant source of evils to mankind. A seden-
tary life, the use of crude indigestible food, de-
pressing passions, gout, haemorrhoids, and an he-
reditary predisposition, are the chief causes of
these affections, which are generally attended with
hypochondriasis and hysteria.
Patience and perseverance are requisite as w’ell
in the patient as in the physician ; the inconstancy,
want of confidence, and impatience of those who
are thus affected, especially when a medicine fails
in producing the looked for effects, combined with
the frequent errors in diet which they commit, are
the chief causes why these affections are so diffi-
cult of cure.
INFARCTUS.
Joachim K. a surgeon from Hungary, twenty-
four years old, of a choleric temperament, black
hair, sallow complexion, and robust habit of body,
two years ago, had an obstinate intermittent fever,
which he did not get rid of for several months ;
since when he suffers from ennui, dislike of occu-
pation, and loss of his spirits.
On the 2d of February, 1823, he came into the
clinical hospital, he complained of frequent head-
aches, with being cast down and gloomy, so much
so as to shed tears ; his tongue was white, he com-
plained also of loss of appetite, though he ate as
much as a person in good health would ; he had
a bitter eructation and tightness at the stomach,
his breathing was attended with an oppressive
dragging pain and distention, the belly was en-
larged and tense, the bowels costive, his ideas
were always gloomy, and his thoughts directed to
his complaints ; Decoct. Gram. 3viij ; Sodas sulph ;
C H9 2
Mellag. gram, a ^ss. After six days use of this
remedy he found himself something better: the
following pills were ordered, Ext. Menyanth ;
Sapon. dur. ; Fell. Taiiri inspiss. a 5j ; Rhei ; Ext.
Chelidon. maj. a 5ss. Calami pulv. q. s. ad formand.
Pil. gran, trium ; sumat quatuor nocte et mane.
When the bowels did not act, a solution of Sodae
sulph. in Dec. Gram, was given: the patient was
much better, he became more cheerful, his belly
softer; he said that he felt better than he had
been for many years ; and in order to undertake
a journey, which in such cases is often better than
medicine, he left the hospital.
CUTANEOUS AFFECTIONS.
Scabies.
In the cure of this complaint, we must distin-
guish between what lately appeared, and that
which has been of some continuance. In the first
case it often readily yields to cleanliness and a few
external applications, among which sulphur has
the pre-eminence. When it has become chronic,
it often requires a complete change in the hu-
mours: we must shun all those extei’nal remedies
which repress it quickly, but for the most part to
the patient’s detriment; for the most dangerous
acute and chronic diseases are not unfrequently
occasioned by this affection having long before
been too suddenly cured.
The slight case which we treated was that of a
citizen’s daughter, who took it from one of her
female neighbours by contact and the use of some
of her clothes. She had been six days affected
with it, when on the Gth of March she was admit-
ted ; the characteristic pustulous eruption, which
c 180 3
itched towards evening, and from the warmth of
the bed, was evident on the hands and fingers. By
a sedulous washing with soap, and rubbing the
affected places with sulphur ointment, the erup-
tion was removed within eight days, and the pa-
tient freed from all unpleasant feelings.
DISCOLOEATIONS.
Jaundice.
In the two cases of jaundice which occurred
this year, of which one was the consequence of
obstructed liver, the other appeared after a fit of
anger, mild deobstruent remedies, with neutral
salts, were very beneficial ; they were soon radi-
cally cured.
ICTERUS EX OBSTRUCTIOXE HEPATIS.
Maria Gelinek, a stout female, twenty-four
years old, came on the 12th of December into
the clinical hospital. She had been ill for several
months ; the white of the eyes was quite yellow,
as also the skin of the face and other parts of the
body, the tongue white, her appetite diminished;
she felt an oppressive pain in the region of the
liver, the bowels were costive, the urine of a dark
colour, and having a yellow froth ; it tinged linen
yellow, the pulse tranquil. Ordered, Dec. Gram,
et Tarax. cum Potass, tart, et Mellag. Gramin.
with cataplasms to the right hypochondrium. She
had several stools from the medicine, and was
much relieved. On the 16th, the pain about the
liver had greatly diminished, the yellow tinge of
the skin was likewise less ; she had no inclination
for food. On the 20th of December, all unplea-
sant sensation in the right hypochondrium had
ceased. The Decoct. Rad. Saponar, which is of
c 181 :i
singular efficacy in jaundice, was given with Tinct.
Stomachica (Tinct. Gent. comp, et Cinnam. cum
Ext. Absynth. et Potass, subcarb.), and continued
for some days ; afterwards, instead of the latter,
Spir. jEth. nitr. was added ; by degrees the appe-
tite returned, the yellowness was nearly gone, the
urine resumed its natural colour, and often depo-
sited a grey slimy sediment ; her bowels became
regular, and she left the hospital cured on the
16th of January.
ICTERUS EX ANIMI PATHEMATE.
Anna Stika, a girl sixteen years old, fell into a
jaundice, after having been in a violent passion.
She felt herself very languid, and had no appetite;
her face, eyes, and tongue were yellow, her taste
bitter, the liver free from pain, the urine deep red,
the pulse regular; Decoc. Gram, et Tarax. cum
Pot. tart, was first given ; then Dec. Sapon. cum
Pot. tart; and afterwards with Tinct. Rhei aquos;
lastly, Dec. Saponar. alone. By these remedies
she was quite cured within the month.
DISEASES OF THE NUTRITIVE FUNCTIONS.
Phthisis Pulmonalis.
The experience of ages pronounces the fearful
decision, that among the diseases of our frame,
phthisis is the most fatal and most destructive of
the human race. Two-thirds of those, says Syden-
ham, who die of chronic diseases are cai'ried off
by consumption ; and certainly this monstrous
mortality has not diminished during the century
which has elapsed since the time of that gi'eat
man ; of this the bills of mortality of all great
cities give the most undeniable proof. Hospitals
are the fertile scene for observing this dreadful
calamity in its complete development ; for to these
R
c: 182 D
the unfortunate patients flock, after months or
even years of suffering, to obtain the last succour.
It is revolting to the friend of humanity to ob-
serve, in its whole extent, nature (in general so
full of resources) yielding to this destructive ma-
lady, and seeming to exclude all human assistance;
and if it is a gratifying proof of the progress of the
healing art in our times, that out of a hundred
cases of acute disease (malignant epidemics ex-
cepted) on the average from 92 to 96 are cured,
in purulent phthisis the ratio must be inverted ;
for when this disease is once formed, many of the
ablest physicians have so far doubted of the^ pos-
sibility of its cui’e, as to hold that those said to
be cui'ed of it, were only cases* of phthisis mu-
cosa, and that an error had been made in the
diagnosis. Still many examples from experience
are produced to shew that the complete purulent
phthisis, however seldom, does sometimes admit of
perfect cure; but tlie objection may still be made
whether such cases were really phthisis pulmonum
purulenta : when a cure takes place, we have no
criterion to decide it ; but when the case is fatal,
we have one less liable to deceive, viz. the post
mortem examination. If this in all cases of
phthisis purulenta exhibits absolute destruction of
the lungs from suppuration, it appears from those
few patients who, by the same symptoms and
course of the disease, truly represented Boer-
haave’s classical picture of it (Aphor. 1206.), and
yet recovered, that this doubt must fall to tbe
ground.
A cure often takes place when large vomicas,
the consequence of peripneumony, burst by de-
grees, and fortunately discharge themselves by
the aerial passages. Much less frequently is this
c 183 ;]
the case in the most usual kind, the tubercular
phthisis; and the possibility of cure in this is
doubted for many weighty reasons ; nor can we
a priori state which cases are capable of such a
rare and fortunate termination. But that it does
sometimes take place, I think the two following
cases will prove: —
The wife of a beggar came in 1816 with con-
firmed phthisis into the hospital. By the use of
emollient mucilaginous remedies, small bleedings
and leeches, Hydr. sub.. Digitalis, blisters, Poly-
gala amara. Ext. Salvi®, Lichen and Cinchona,
after four months she appeared, in my judgment,
cured. I saw her in February 1817, and she was
free from all cough and affection of the chest. In
May, she was brought into the hospital with ge-
neral dropsy, without any complaint of the chest,
and died ten days afterwards. On opening the
body, the lungs were observed to be sound, with-
out induration or pus ; but in the two upper lobes
there were numerous cicatrices, which extended
deep into the parenchyma ; whence the former
diagnosis appears to have been right.
Another woman, forty-eight years old, was in
the year 1818 treated for a confirmed phthisis and
morbus caeruleus; the cough, expectoration and
fever entirely disappeared in four months; the
worn out patient recovered her flesh and good
looks, and was discharged. The morbus caeruleus
remained. In 1824 she came again into the hos-
pital, and died from its effects. On examination,
the foramen ovale was found open, the lobes of
the left lung united, and where the division should
be, there were many cicatrices (which could not be
mistaken) of former ulcerated surfaces. Laennec
has brought forward several cases of this kind.
C 184 ]
Consumptions belong to the order of Mar-
cores, which are divisable into several genera, not
from the name only, but from their essential dif-
ference ; and the designation of them is of con-
sequence, as far as regards their diagnosis and
cure. Although this difference has been known
by physicians of every period, it is to be lament-
ed, that through the arbitrary use of the names
of diseases, great confusion has been brought into
ideas on this subject, whilst notwithstanding the
excellent descriptions from nature, quite different
diseases are by some designated by the same
name, whilst others disagree in the translation of
those names. So Sachleben distinguishes Tabes,
Febris hectica, and phthisis, but he translates
Tabes by consumption. Morton calls the falling
away of the muscular parts of the body, which
comes on from removal or colliquation of the liquid
parts with or without fever, phthisis ; and divides
it into wasting (atrophia), and consumption phthisis
pulmonalis. Van Swieten designates clearly these
terms, when he says “ ^6t<riq, a corrumpendo dicta,
sed obtinuit apud medicos ut hoc ocabulum non
sumatur pro qu^libet corruptione, sed pro totius
corporis in suo habitu consumptione, nat& ex caco-
chymi^ purulent^, prmdominante, ubicunque demum
fomes hmserit in corpore. Atrophia est defectus
nutritionis quum corpus ex ingestis non reficitur.”
But he makes no marked difference between Atro-
phia and tabes, as he defines tabes, “ ubi deficiens
nutritio non restituit perdita.” The great Stoll
calls the falling away of the body with slow fever
tabes; without fever, atrophia; with collection of
matter (minera purulenta), phthisis; but notwith-
standing this division,which is grounded in nature,
he afterwards considers phthisis and tabes as sy-
C 183 3
nonymous. A. G. Richter makes consumption
(phthisis) and wasting (tabes) as meaning the
same thing, and understands hereby that state of
disease by the continuance of which a diminished
vegetation and reproduction is effected.
It appears hence desirable to explain these
ideas in a manner corresponding with the differ-
ent nature of the diseases, and the most correct
modes of expression. Consumptive diseases, in
general, are chronic states of disease, manifesting
themselves by a gradual decrease of the frame in
its size and stren^h, with or without fever.
These consumptive affections are divisible into
five genera, according to the cause which occa-
sions the diminution of the body. 1. Consump-
tion (phthisis), gradual wasting with fever, evinced
and kept up by the suppuration of any oi'gan. 2.
Wasting (tabes), gradual loss of flesh and strength,
manifested, and kept up by the want of nutrition ;
when this want of nutrition is grounded in the
gradual extinction of the assimilative powers, as
in old age, it is called marasmus. 3. Starvation,
(atrophia) wasting of the body and strength, from
the bad quality of the food. 4. Hectic fever
(febris hectica), is that symptomatic fever which
accompanies the gradual wasting of the body and
strength, from a morbid though not suppurating
state of some organ. 5. Slow fever (febris lenta),
is a fever connected with general loss of flesh and
strength, which exceeds an acute fever in dura-
tion, and is not the effect of any diseased viscus.
As the viscera vary, so when by their suppura-
tion the flesh and strength are wasted, they give
rise to as many kinds of phthisis. Among these
the most common is the purulent consumption of
the lungs, whence this is by pre-eminence named
K 3
c: 186 ]
phthisis. In its outset, by a proper treatment, it
for the most part admits of relief. ]SIorton long
ago s^id, “ Phthisis aeque certam curationem
atque alii morbi admittit, modo debits, methodo
satis tempestive tractetur.” The rules of this
treatment are throughout grounded on the sup-
position that phthisis pulmonalis is a state of chro-
nic inflammation, and that it must be treated with
this view, at the same time great attention is to
be paid to its cause, and to the particular state of
the patient; hence a very difierent mode of treat-
ment may be required.
PHTHISIS PULMONALIS PURULENTA.
The case of a young man, nineteen years old,
may serve as an example of the treatment; his
name Johann R. his occupation a turf-cutter, he
was of a consumptive habit, born of consumptive
parents, and had already lost two brothers in this
disease. He had recovered from the small-pox
about two years ; four months ago he was seized
with complaints in his chest, and a violent cough,
to which he paid little attention, and took no ad-
vice.
With the use of domestic remedies, some of
which were improper, he became daily worse, lost
all appetite, was evidently more emaciated, and
febrile symptoms with increased heat came on
dail}^ especially in the afternoon, which ended
during the night with profuse sweat, by which,
and the troublesome cough, he was deprived of
rest and sleep, and his strength soon exhausted :
to this a diarrhoea contributed, which was brought
on by the excessive use of liquids, required to sa-
tisfy his constant thirst.
In this state he was on the 12th of June admit-
c 187 :i
ted Into the clinical hospital. The patient was
extremely reduced, and so weak that he could
not remain out of bed ; he coughed with great ex-
ertion, and brought up a quantity of yellow matter
in globular masses ; besides the pain occasioned
by his cough, he complained of difficult breathing
and tightness at the chest, great lassitude, and
want of sleep, the pulse was very quick and con-
tracted. The most urgent indication was to re-
lieve the pressing symptoms to restrain the diar-
rhoea, and quiet the troublesome cough. Both
were satisfied by mucilaginous, emollient, soothing*
remedies, viz. Decoct. Salep. et Dec. Sem. Lini
cum Extr. Hyoscyami, and with good effect. The
immoderately increased vascular action, was, how-
ever, lessened by Powders with Digitalis. The
cough was soon easier, the expectoration less,
the stools not so frequent. A circumstance which
greatly retarded the progress of his amendment,
■was the night sweats ; these had hitherto not only
not diminished, but they occurred also in the day-
time ; for no sooner had he composed himself in
any way to quiet or slumber, than he was bathed
in sweat, with which in a short time his linen was
completely soaked.
To remedy this, the Ext. Fol. Salviae was
brought into use ; a remedy which had already
so often recommended itself to us by its excel-
lent effects, as a gentle tonic without any stimu-
lus, in subduing the excessive perspiration the
consequence of debility, and at the same time
bettering the appetite. This was given at first
with emollients ; afterwards, w'hen the cough ad-
mitted, it was joined to bark as in the following
formula; B. Cinchonas 5ij. ; Rad. Salep. gr. xij.
ft. Decoct. Col. *viij. adde Ext. Salvias 5j; Sacch.
c 188 :]
pur. 5ij. Sweet whey was ordered for his drink,
and he was recommended to keep out of his bed
as much as possible.
The effect of this treatment was beyond expec-
tation propitious ; he who lately was unable from
weakness to support himself, worn out and con-
fined to his bed, recovered astonishingly, gained
a better look, was able by degrees to remain all
day up, even to pass a few hours in the open air,
and acquired both flesh and strength ; the chest
was free from complaint, he had indeed cough,
but slight and with trifling expectoration ; the
evening febrile attacks as well as the perspiration
had entirely disappeared, the pulse was soft and
quiet, his appetite excellent : though the expec-
toration had considerably diminished, it had not
lost its purulent character, and a morbid sensibi-
lity of the chest to external influence was still ob-
servable; for when he remained longer than usual
in the air, or if the weather was less propitious,
the cough was increased, a certain sense of tight-
ness troubled him, and in this state it was neces-
sary to desist from the tonic remedies and change
them for emollients. In this improved state into
which he w^as within six weeks brought by the
aid of medicine, he thought himself almost com-
pletely cured, and his circumstances requiring it,
he desired to be discharged, which took place on
the 21st of July in spite of all remonstrance, hav-
ing a due regimen pointed out to him, and being
not absolutely cured, but greatly relieved.
DISEASES OF THE NERVOUS SYSTEM.
Colic.
In every case of colic, we are to be upon our
guard of its tendency to pass into inflammation ;
C 189 1
most cases of it indeed depend on inflammatory
irritation, and hence do not belong to nervous dis-
eases, but rather to the class of pains. The per-
nicious, and among the lower ranks, common
practice of giving in pains of the belly, heating
remedies, such as brandy, often with pepper, ac-
cording to their notion, to strengthen the intestines,
expel wind, and allay the cramp, is a chief cause
that they so often terminate in inflammation;
by the heterogenous irritation a sudden relief
appears to follow, but the pains return with in-
creased energy, when, unfortunately, the quantity
of the spirit is usually doubled, and in this man-
ner the most serious inflammations of the bowels
are brought into our hospitals.
The case which occurred was that of a men-
strual colic.
COLICA CATAMENIALIS.
Anna Rubisch, a stout married woman, twenty-
four years old, always regular at her periods, in
May 1823, had one which was unusually abun-
dant and protracted. A physician ordered tinc-
ture of cinnamom with astringents, which very
soon checked the discharge ; but she now felt
violent pains in the abdomen, had slight febrile
attacks, and was confined in the bowels. These
symptoms indeed remitted, and returned peri-
odically, and on the 27th of May the menses
again made their appearance. When on the 30th
she came into the general hospital, she com-
plained not only of frequent griping, but also of
violent pains in the loins ; she was costive, the
abdomen painful on pressure, the pulse quiet, the
discharge from the uterus pale, and in small
quantity. Decoct. Alth. Mannat. emollient glysters,
c 190 :i
and similar cataplasms were ordered to the belly.
She had some relief from the bowels. On the
1st of June, Emuls. gummosa was ordered, and as
the pain continued, six leeches were applied to
the abdomen, by which she was much reUeved.
But as she had several loose stools during the
day, on the 2d of June Dec. Salep. spiss. cum
Syrup, papav. was given, and she went on with
the other remedies ; afterwards, she took Dec.
Salep. Jcum Ext. Hyoscyam. et Saccharo. The
discharge ceased by degrees, and from the con-
tinued use of these remedies all unpleasant symp-
toms disappeared. She left the hospital cured
on the 10th of June.
Co?wulsions.
Spasms belong to an extensive class of sufferings
which especially affect females and children. The
disease consists in a morbid contraction, tension,
and thickening of a part ; its characteristic signs
are diminution of the circumference, cold and
paleness, generally attended with pain, which
manifests itself by cramps, contortions and con-
tractions, and which are often periodical. Spasms
are indeed, especially in hysterical subjects, often
primary, though in most cases they are secondary
symptoms, and of which, as such, the most oppo-
site diseases are the causes ; hence their treat-
ment requires considerations as various as are
those causes. In tender infancy, they are both
frequent and fatal, especially when being consi-
dered merely as nervous symptoms, they are
treated with stimulating and antispasmodic reme-
dies. In general, an inflammatory state of the
brain or gastric affections (which by sympathy
bring on irritation in that organ) are the primary
c: 191 ;]
causes of what are termed fits (Eclampsia).
These require the most particular attention, and
are by no means to be treated with stimulating
remedies. The case of convulsions, which occurred
in the clinical hospital, was the following : —
Convulsiones.
Antonia Strakin, a very fine young woman, was
in the beginning of July treated in the clinical hos-
pital for a pleurisy and cured. Scarcely dis-
chai’ged, she had on the following day a violent
quarrel, in which her anger was very much ex-
cited, so that she fell into convulsions and cramps,
could not speak ; a contracting pain in the throat
and breast took away her breath, and vomiting
had more than once taken place. In this state she
returned on the 22d of July into the hospital ; her
countenance was pale, she was speechless, had
great anxiety, her breathing asthmatic, very rapid,
with a tight pain under the sternum ; the pulse
was spasmodically contracted. She was bled to
four ounces, and the following ordered, R Aq.
pur. 5'^j j Potass, supertart. 5*ss ; Test, praep.
Sacch. pur. a 5j : a table-spoonful to be taken
every hour, shaking the phial ; she had also glys-
ters, with Infus. Anth. et Sod. mur. and a sina-
pism to the pit of the stomach. She was soon
relieved ; was able to utter some inarticulate
words, and was more quiet ; but the convulsive
attacks returned, she could not speak, was
threatened with suffocation, the upper extremities
were convulsed ; four drops of Tinct. Opii were
given with sugar. These attacks returned several
times during the day, and were equally severe.
Ordered, Aq. meliss. Ext. Ilyos. gr. iij. Aq.
Castor. 5iij ; Sacch. purif. 5ij; also Zinci oxyd.
n 192 3
gr. iij ; Sacch. pur. 5j ; m. f. pulv. div. in dos.
sex. one to be taken every three hours ; and to
take frequently some chamomile tea. The fre-
quency as well as the violence of the paroxysms
decreased; she next took Aq. Meliss. 5iv; Liq.
Ammon. Succin. 5ss; Sacch. pur. 5ij. On the
27th she had quite recovered; on the 30th she
went home, and was not afterwards afiected with
convulsions.
Giddiness.
Though vertigo is for the most part a symptom
of very different diseases, yet sometimes it appears
as a primary complaint. With the latter, a tall
young man, a law student, came on the loth of
June into the clinical hospital ; he had been
troubled with it as his chief complaint for five
years, and according to his account, he had never
been quite free from it. Occasionally it came on
with such violence as to deprive him of sight, and
he was obliged to seize the first object to prevent
his falling to the ground. He assigned as a cause,
the too great application of his mind, and study
during the night. Leeches, blisters, and other
stimulants to the skin, as also various inward re-
medies had been tried. His look was pale, the
cheeks slightly flushed, the pupil somewhat di-
lated, the mucous secretion from the nose had
disappeared for some months, yet the air passed
freely through the nostrils ; his tongue was clean,
the chest and abdomen free from complaint, he
was rather costive, but free from fever, his pulse
full, and tolerabl)' strong.
1 hough in this case, rest, and a temporary
cessation from study', as the exciting cause, was
the chief indication ; as he wished it, an attempt
C 193 3
at his cure was made, and on the 15th of June
he was ordered Aq. meliss. 5 Pot. supertart.
Test praep. a 5j ; Sacch. pur. 5y. The fresh bark
of mezereum was applied to the upper arm to
make an issue ; occasionally a tepid solution of
manna was directed to be drawn up the nostrils,
and to prevent the costiveness glysters were di-
rected. By the 20th the attacks were less frequent.
Ordered, Aq. meliss. ^iij > Valerian. 5u 5 Biq.
Ammon. Succin. 3ss; and as this mild nervine
medicine gave considerable relief, the attacks were
less frequent, and never so violent as before ; the
following was afterwards ordered, Aq. Menth.
satio 5'v ; Tinct. nervin. tonic. Bestucheff, gutt.
XV ; to take a table spoonful every three hours.
With the use of these remedies his health had
so much improved, that he was able to go about
alone, and walk in the garden without danger,
though he often experienced a slight threatening
of his complaint.
He was advised as the season was favourable,
to go into the country, there to take an infusion
of bark in whey, and ordered as much as possible
to abstain from too much application. He set
out on the 8th of July and came back in the au-
tumn without having had any attack during his
absence.
* Iron dissolved in nitro-muriatic acid, evaporated, and again
dissolved in aether and alcohol.
S
CLINICAL ANNUARA^
FOR 1824.
In the clinical medical school for surgeons dur-
ing the season of 1823-24, from the beginning of
November to the end of August, 130 patients
were submitted to its care, and served for its in-
struction. These consisted of forty men and
ninety females ; with respect to their condition in
life, they were chiefly students, trades-people, ar-
tisans, travellers, servants, and married women ;
they were generally brought, as commonly hap-
pens in hospitals, with their diseases already
formed, and often in their most advanced state.
With respect to the different kinds of diseases, to
answer the object of the clinical school, a prefer-
ence was given, in selecting them out of the wards
of the general hospital, to the most prevalent dis-
eases, particularly those which marked the sea-
son or were general among the people ; without,
however, excluding any form of disease. Of
those treated, 113 were cured; eight died; viz.
c: 195 ;]
two men and six women ; three were discharged
as incurable (two cases of consumption and one
of affection of the heart) ; six were at the close of
the season transferred to the wards of the general
hospital, where they all did well.
If we compare the number of patients with
those of the former year, it appears that this
year eleven less have been admitted. The cause
of this small difference was the ]>revalence in
that year of the contagious typhus and measles,
many cases of which were received into the clini-
cal school ; this year, on the contrary, there has
been no contagious epidemic. The students were
this year in number fifty-three. Each of whom
had the charge of certain cases under the guid-
ance of the professor; the particular history of
which they had to make out with clearness and
truth, to note with the greatest exactness the
course of the diseases, and to read this daily to
the class.
The cases treated were in the order of their
admission as follows : —
NOVEMBER.
1 Febris inflaimnatoria gas-
trica cum aflfectione pleurae
2 Phrenitis
3 Arthritis chronica
4 Febris rheumatica dein ner-
vosa stupida
5 Febris rheumatica subner-
vosa cum tumoribus glan-
dularum subcutanearum
6 Hepatitis
7 Febris catarrhalis cum affec-
tione tracheae
8 Febris puerperalis f
9 Coxalgia spuria
10 Pleuritis traumatica
11 Peripneumonia cum affec-
tione pleurae
12 Tussis chronica cum affec-
tione bronchiorum
13 Angina faucium cum febri
in charaetcrem nervosum
versa
14 Febris rheumatica subner-
vosa cum affectioue pectoris
15 Ptyalismus
16 Febris gastrica
[ 196 3
DECEMBER.
17 Phthisis pulmonalis puru-
lenta ex haemoptoe proe-
gressa +
18 Pleuroperipneumonia
19 Arthritis acuta
20 Febris nervosa stupida ex
gastrica orta
21 Febris rheumatica gastrica
ill febrem iiitermittentem
larvatam sub forma cepha-
lete versa
22 Febris rheumatica in nervo-
sam versa
23 Angina membranacea
24 Splenitis +
25 Febris rheumatica infiam-
matoria cum erjripelatt
pedum
26 Febris inflammatoria rheu-
matica cum affectione mus-
culorum intercoetaliuth
27 Rheumatismus inflammato-
riuB
28 Spasmi cum affectione ven-
triculi
29 Phthisis pulmonalis •
30 Tracheitis et bronchitis
31 Arthritis acuta
32 Febris gastrica suburralis
JANITARY.
33 Bubo metastaticus
34 Urticaria
35 Febris rheumatica
36 Ai-tliritis acuta
37 Febris gastrica
38 Chlorosis
39 Apoplexia et hemiplegia*
40 Febris rheumatica
41 Epilepsia
42 Arthritis acuta
43 Febris gastrica saburralis
44 Arthritis acuta
FEBRUARY.
45 Hepatitis chronica
46 Phthisis pulmonalis*
47 Pleuritis dextra
48Haemoptoein phthisin versa+
49 Metrorrhagia
50 Febris caterrhalis cum affec-
tione membranse Schnei-
derian® ex polypo evulso
51 Febris catarrhalis subuen'osa
52 Rheumatalgia
MARCH.
53 Vitium cordis organicum *
54 Ptyalismiis
55 Febris intlaminatoria gastrica
in febrem intermittentem
desinens
56 Febris rheumatica subiicr-
vosa
57 Febris intermittens tertiana
58 Pleiuroperipneumonia
59 Scarlatina
60 Pleuritis dextra
61 Metritis chronica
62 Febris gastrica
63 Peritonitis et Oophoritis
APRIL.
64 Enteritis chronica
65 Febris catarrhalis nert'osa
66 Sj^pliilis
67 Hepatitis
68 Ccphaloea
69 Febris rheumatica gastrica
70 Angina tonsillaris ^
71 Plcuroperipneunmnia
72 Febris rheumatica gastnea
in iiervosam versa
73 Febris inflammatoria cum
affectione faucium
[ 197 3
74 Hypochondriasis 77 Febris intermitteiis tertiaiia
75 Pleuritischronicaetsyphilis+ 78 Hepatitis et enteritist
76 Febris rheumatica
79 Peripneumonia
80 Febris rheumatica cum affec-
tione pleurae
81 Peripneumonia
82 Ischias
83 Hepatitis
89 Angina tonsillaris
90 Pleuritis rheumatica
91 Pleuroperipiieumouia
92 Peripneumonia
93 Pleuroperipneumonia
94 Enteritis
95 Febris inflammatoriagastrica
96 Arthritis acuta
97 Pleuritis sinistra
xMAY.
84 Pleuroperipneumonia
85 Febris intermittens tertiana
86 Pleuritis rheumatica
87 Febris inliammatoria rheu-
matica
88 Pleuritis sinistra
JUNE.
98 Febris rheumatica cum af-
fectione pleurae
99 Epilepsia
100 Febris rheumatica
101 Pleuritis rheumatica
102 Erysipelas faciei +
103 Splenitis
104 Febris gastrica saburralis
JULY.
105 Febris rheumatica
106 Eadem cum affectione, he
patis in nervosam versa
107 Pleuroperipneumonia
108 Tussis chronica
109 Hydrops
110 Otitis ct angina
111 Arthritis acuta
112 Febris nervosa
113 Convulsiones
114 Febris rheumatica
115 Haematemesis
116 Phrenitis lactea
117 Peripneumonia et angina
suppuratoria
118 Metrorrhagia
119 Pleuritis et syphilis
AUGUST.
120 Febris inflammatoria rheu-
matica cum collo obstipo
et angina faucium *
121 Hydrothorax acutus
122 Febris rheumatica gastrica
123 Hydrothorax inflammato-
rius*
124 Febris gastrica saburralis
125 Pleuritis et ulccra syphi-
litica*
126 Haemorrhoides
127 Pleuritis in subjecto syphi-
litico*
128 Febris biliosa nervosa dein
putrida+
129 Phrenitis lactea
130 Colica inflammatoria *
These cases arranged in systematic order, afford, according to
my table on fevers and chronic diseases, the following view. ; —
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C 200 ;]
STATE OF THE WEATHER AND PREVAILING CHA-
RACTER OF THE DISEASES.
The winter of this year was generally mild,
without much cold or snow. The spring was
cold and raw, and though abundant rains set in,
vegetation was backward. Even the summer
continued uncommonly cold and moist, and at
midsummer there Avere unusually violent rains and
inundations.
The stationary character of the diseases was in
general the mild inflammatory, with a peculiar
tendency to pass with more readiness and fre-
quency than usual, into the nervous type ; this
was no doubt influenced by the state of the wea-
ther and the prevailing cold. The nervous cha-
racter, however, was, in most cases, not com-
pletely developed, and appeared rather as an
incipient nervous aflTection ; the treatment ^ was
therefore in general moderately antiphlogistic,
avoiding too frequent blood-letting. hen the
sub-nervous state came on, a quiet observant
practice was employed with advantage, in order
not to disturb nature in her operations towards
effecting a crisis.
PARTICULAR STATE OF THE WEATHER IN THE DIF-
FERENT MONTHS, WITH A DESCRIPTION OF THE
TREATMENT OF EACH DISEASE.
GENERAL STATE.
Highest
Lowest.
INIean . .
NOVEMBER.
liar.
29.022. . ,
28.115.. .
28.5GG. .
'I'lier.
c: 201 ;]
The prevalent winds were the south-west and
north-west. November set in with storms of rain,
with cloudy and cold weather. Snow fell on the
10th, with a violent north wind ; the cold dimi-
nished after the middle of the month, the weather
continuing stormy, towards the end it became un-
usually mild, for the season, and like a clear
autumn.
The prevailing character of the diseases was
in the first half the inflammatory rheumatic, in
the second it inclined to the nervous ; the most
frequent diseases were, among the acute cases,
inflammatory pleurisies, puerperal fever, inflam-
mations of the brain, and nervous fevers ; among
the chronic diseases, were coughs, consumptions
and many dropsies. The practice pursued in the
inflammatory pleurisy was the antiphlogistic, ge-
nerally with blood-letting ; but there was often a
gastric affection connected w'ith it, made evident
by a coated tongue, disordered taste, tightness at
the praecordia, and looseness ; in such cases it was
necessary to unite solvent with antiphlogistic
remedies, though emetics were not indicated.
In these circumstances the muriate of ammonia
was of excellent service. The inflammations of
the brain took place chiefly in persons given to
drink, they I’equired copious venesection, with
cold applications to the head, and derivative re-
medies. In the puerperal fever, the antiphlogis-
tic treatment was employed, seldom with general,
but often with topical blood-letting.
The nervous character of the fevers declared
itself by heaviness or lightness of the head, ring-
ing in the ears, frequent aberration of the mind,
dry tongue, great thirst, diarrhoea, and dry skin ;
the pulse was in general moderately frequent, not
C 202 3
hard, but sufficiently strong. In this case one
might be assured that the disease would not ter-
minate in less than from seven to eleven days; a
moderate support of the powers of life by Rad.
Caryophyllat®, muriate of ammonia and blisters,
generally brought about the desired termination.
PHRENITIS.
On the 9th of November, two men, attacked
with violent inflammation of the brain, were ad-
mitted into the general hospital, their symptoms
wei'e very different. One of them was a coach-
man, thirty-three years old, of a strong make,
much addicted to strong drinks, and to excess of
anger. On the 2d of November, without any
known cause, he felt himself ill, with great lassi-
tude, loss of appetite and headache. He still
went on with his occupation, but on the 6th he
suddenly became delirious ; he was very restless
at night, and had great thirst and heat, he went
on in this way till the 9th, when he was admitted
into the clinical school.
He raved much, was indignant at his relatives,
who he thought were aiming at his life. When
asked what he ailed, he complained of pain and
great heat in his head, this was uncommonly hot,
his countenance flushed, his eyes rolling wildly,
with defiance in his look, his tongue moist and
white, his breathing free, though occasionally he
sighed deeply, and had a cough ; his bowels were
confined, his abdomen soft, the urine scanty, rather
red, the skin warm and moist, the pulse uniform,
moderately quick, full and hard. Ordered, to be
let blood to eight ounces, cold applications to the
shaved head, glysters with salt, sinapisms to the
calves of the legs ; inwardly, Dec. Alth. cum
c; 203 n
Magnes. sulph. In a few hours after the bleeding
he became quiet, the delirium abated, and on the
following day his I’eason completely returned,
there was no inflammatory crust on the blood ; he
had yet had no stool, and there was something
strange in his look; he went on as before, and
took, moreover, half a grain of calomel every two
hours.
On the following day he was altogether better,
he had still a dull headache, with a cough, his
thirst moderate, he had had two purging stools,
the pulse was moderately quick, and powerful,
but ^not hard ; the urine threw down a white
slimy sediment. The powders were omitted, the
cold applications laid aside, and instead of the
Magnes. Sulph. fifteen grains of Muriate of Am-
monia were added to the mixture. The following
day he had quiet sleep ; though he coughed a
good deal and expectorated slimy matter, his
breathing was not impeded ; the pulse and urine
had almost the natural appearance and his appe-
tite returned. Decoct. Tussilag. cum Ext. Hyos.
was given on account of the cough, and on the
22d of November he returned home cured.
In this case of phrenitis, which had existed
three days, a moderate venesection gave immedi-
ate relief. In many such cases eftusion takes
place on the third or fourth day, and then not un-
frequently all help is vain. A proof of this was
given in the already mentioned case, admitted with
the above, who, on account of suffering from some
other disease, had given himself up to drinking
spirits. On the 5th of November he began to
speak wild and rave ; he called frecjuently for beer
to allay his violent tbirst, which had unfortunately
been given him till the 9th, when he came into
C 204 ;]
the general hospital, with all the symptoms of a
confirmed phrenitis ; violent fever and constant
trembling (delirium cum tremore). Repeated
bleeding, leeches, cold applications, and the other
antiphlogistic means were employed, but the day
following he died. On opening the head, the ves-
sels of the scalp were observed turgid with blood,
the dura mater in many places adhering to the
cranium by pseudo-membranes, particularly along
tbe longitudinal sinus ; the vessels of the coats of
the brain were turgid with blood ; there was on
the pia mater a white, granular, unctuous mass,
with a considerable quantity of exuded lymph.
The substance of the brain solid and full of blood,
and more water than usual in the lateral ventricles.
The head was large and covered with an unusual
quantity of fat ; the abdominal viscera in a natural
state.
The great Vogel remarks with truth, that the
hardness of the pulse alone, in inflammations of
the brain, gives no indication for the repetition of
blood-letting ; for the pulse in this case remained
hard after the last bleeding, which was indicated
by the other symptoms ; when it suddenly became
vibrating and not to be counted, and death soon
followed. Blisters, calomel, flores arniem, which
were employed, as far as the short period admitted,
were unable to efiect any relief, eflusion having
previously taken place.
FKBRIS NERVOSA STUl’IDA.
A shoemaker, forty-seven years old, of mode-
rately strong habit of body, having enjoyed good
health, was, on the 7th of November without cause,
taken with shivering and heat, and with sharp
dragging pains in the limbs ; he took no care
n 205 3
about his complaints, and after a week came into
the clinical school. T. he head was free from pain,
his countenance natural, the tongue white, thirst
moderate, chest and abdomen free, but the above
pains along the spine made it difficult for him
to raise or turn himself; the heat of the skin was
increased, the pulse moderately frequent and
strong. Ordered, Inf. FI. Samb. cum Liq. Amm.
acet. 5hj. et Roob Samb. ^ss. However slight
this case might appear, he passed a very restless
night ; his countenance lost its animation, his eyes
became dull, he had on the following morning dif-
ficulty of hearing and tinnitus ; the urine pale red,
with a floating cloud ; the skin hot and dry, the
pulse quick, small, and soft — evident symptoms of
the incipient nervous state. Ordered, Inf. R.
Caryoph. cum Liq. Am. acetat. On the following
day the tongue was more coated, and at night in-
creased headache and delirium came on ; the pulse
remained moderately frequent and soft ; a blister
was placed between the shoulders, and instead of
the Liq. Am. acet. fifteen grains of Ammoniae mur.
were given. In the following days delirium and
stupor alternated, the pulse became extremely
tardy and small, and the skin dry ; he had a daily
evacuation from the bowels. For this depressed
state of his strength, two grains of camphor were
added to the mixture. Still the nervous character
became more established, for on the 18th there
was great stupor, heaviness, pale countenance, a
dry tongue with a dirty covering and cracks, the
pulse more sunk, small and weak. As the stupor
was now the prominent symptom, Flores Arnicas
were given according to the following formula,
find the blister was repeated : Rad. Caryophyll.
5iij. Flor. Arnicae 5iss ; fiat. Infus. fervid. Col
T
n 206 ;]
3viij. adde camphor, (mucilag. Acac. subact.) gr.
iij. In this state he went on to the 17th day, and
now by the desiccation of the mucous membranes
a dry cough came on ; but the tongue began to
clean, and its coat to separate; the cough became
moist, the skin perspired freely, and the urine let
fall a mucous sediment. These critical symptoms
continued in a moderate degree, and the state of
recovery commenced. For the cough and viscid
expectoration, emollient mixtures, with Antira.
sulph. praecip ; Decoct. Polyg. amar. cum Spir.
Ammon, anisat. were employed, and at last De-
coct. Cinch, et Polyg. amar. ; on the thirty-sixth
day of the disease he went home cured. In this
case the nervous type became fully developed,
which happened to but few others of this kind in
this year ; commonly, indeed, tinnitus, temporary
delirium, languid look, dry tongue and skin, gene-
rally with diarrhoea, came on, and evinced the
nervous state ; this continued from three to seven,
seldom to eleven days, and terminated always with
perspiration and sediment in the urine, which
now first began to lose its red colour. Till this
ci’itical sediment appeared one could never expect
a return of the digestive powers, or recovery ;
hence, in a practical point of view, it must ever be
considered of importance.
COXALGIA SPURIA.
A rather uncommon case, easy to be mistaken
for coxalgia, happened to a youth twelve years
old, who already for three weeks had suffered
rather severe pain in the upper part of the inner
surface of the right thigh, and joint of the knee,
so that he could only move about limping, with his
thigh drawn up. When on the 17th of November
L: 207 2
he came into the clinical school ; his right foot
was an inch shorter than the left, his pulse ex-
cited, but in other respects he was well. Four
cupping-glasses with scarification were applied to
the great trochanter, and afterwards emollient
poultices ; inwardly. Decoct. Graminis cum Potass,
tart., and perfect quiet, with a horizontal position
was enjoined. On the following day the pain was
much lessened ; on the 20th, his limb had regained
its usual length. On the 25th, he was discharged
cured.
The shortening, which in coxalgia only comes on
in the third stadium, was evidently here occasioned
by the muscles, which, being affected with rheu-
matism, had, by their contraction, drawn the head
of the thigh-bone into the socket, and thus pro-
duced the shortening of an inch.
FEBRIS PUERPERALIS.
On the 15th of November, a case of violent
puerperal fever from a first accouchement came
under our care. The birth had taken place
without accident on the preceding day. Without
a known cause, the patient now complained of
great pain in the abdomen, which soon increased
in violence, and the belly began to swell. When
she came into the hospital, she could not bear the
least pressure on the part, the uterus had con-
tracted itself, the lochia flowed as usual, the
thirst and heat were increased, with a very quick
and oppressed pulse. Leeches and emollient ap-
plications were used to the abdomen, oily glysters,
Dec. Alth. mannat. et Mist. Amygd. pro potu,
were given. The night was very restless, quite
without sleep ; the pains had increased and ex-
tended themselves towards the praecordia, whence
C 208 ]
they extended under the false ribs, and from their
violence caused the patient great anguish ; her
breathing was deep and difficult, but unattended
with cough, the pulse very quick, rather hard and
contracted : she had had six liquid stools. She
was bled to six ounces, and the mistura oleosa
given. Towards evening, she became very much
worse, more restless every hour, the pains still
continued, the skin was dry and hot, the pulse
extremely frequent, and we began to despair of
her life. Eight leeches were applied to the prae-
cordia, and powders, with half a grain of calomel,
given every two hours. (It was the time for the
milk fever to come on.) On the following morn-
ing (the 17th) there was indeed some amendment,
the pains of the abdomen were somewhat abated
and it bore pressure more easily, but it was still
painful, the urine shewed a sediment, the breasts
remained without milk. The leeches were again
applied, and a grain of calomel given every two
hours ; as the symptoms at the evening visit were
the same, as a frequent vomiting had come on, and
the bowels were quite costive, the pulse not seem-
ing to allow of any more bleeding, a tepid bath
was ordered, and afterwards a large blister was
applied to the abdomen ; the dose of calomel in-
creased to two grains, emollient fomentations were
applied to the breasts, and also glasses to attract
the milk to those parts.
On the iSth, she vomited a grass-green matter,
no stools could be procured, the pulse was not to
be counted, the countenance sunk, a cold sweat
covered the surface, and she died in the night.
Examination. In tlie abdominal cavity was
found a quantity of yellow-green fluid, in which
flaky substances floated. The viscera of the ab-
C 209 ;]
domen, especially the peritoneum and the small
intestines, were generally inflamed; the ovaries
were swollen to an uncommon size, hard, and
greatly inflamed. Evident marks of inflammation
were also observed on the diaphragm. The uterus
was properly contracted, though in circumference
remarkably large, its parietes thickened, and its
inner surface covered with a brown purulent
ichor ; the vagina was as if bruised, and the blood
extravasated, of a dark colour and sphacelated.
Every puerperal fever is always a serious, and
often a very dangerous disease ; in which nature,
in other cases so propitious, can, if left to herself,
only tend to an unfortunate issue ; hence the in-
terference of art is always necessary, and how-
ever fortunate the above antiphlogistic treatment
may have been in many other cases, in this it had
not the same desirable effect, the cause of which
seems to have been in the os and cervix uteri
having probably, even during pregnancy, been
the seat of a chronic inflammation, which, after
child-birth, terminated in the sudden death, and
putrefaction of that organ. In general, during
the present autumn, puerperal fevers were more
difficult and dangerous than usual, they were also
more frequent, and almost appeared as if they
would become epidemic, but this did not take
place. This case had a great analogy with the
well described epidemic in the Austrian Medical
Journals of 1822.
DECEMBER.
Bar. Then.
Highest 29.007 58.77
Lowest 28.105 13.55
Mean 28.55G 30.10
T 3
i: 210 :]
The prevailing winds were the south-east and
south-west. During the first fortnight of Decem-
ber, the unusually mild weather continued ; rain
came on afterwards, and in the latter part of the
month, there was a dry frost, followed by snow,
which lay for some days. The nervous character
of the fevers w'hich prevailed in the preceding
month was extended also into this, but the con-
tinued cold which came on about the middle of
the month, produced several inflammatory cases,
yet these were neither frequent nor violent. The
rheumatic fevers as well as those of a gastric type
which occasionally appeared, had a striking ten-
dency to pass into the nervous character, or at
least to assume some of its symptoms. Gout and
rheumatism were pretty frequent.
The treatment employed was, in general, what
has been stated, and the course of the fevers in
general favourable but slow ; the nervous cha-
racter was rather overcome by nature than by the
remedies employed ; it was only in cases where
the disease in its course made unfavourable devi-
ations, or when symptoms of importance, such as
an enervating diarrhoea, which exhausted the vital
powers, that an active interference of art seemed
requisite; in which case, repeated blisters. Rad.
Arnicae, small doses of Sal Ammoniac in union
with salep or other mucilaginous remedies; ipeca-
cuanha in small doses. Aqua Cinnamomi, aura
camphorata, and mucilaginous glysters were em-
ployed.
FEBRIS RHEUMATICA CUM TUMORIBUS GLANDU-
LARUM.
A labouring man, sixty years old, was admitted
into the clinical school on the sixth day of his ill-
c: 211 ;]
ness, with heaviness of the head, tinnitus, a dry
trembling tongue and great thirst. He stated
having taken cold as the cause of his complaints ;
he had pain on both sides of his neck, the glands
appeared as knotty tumours, aud those of the ax-
illa and groin were enlarged to the size of a hen’s
egg, and very painful to the touch ; he had vio-
lent pains in the feet, and the ankles were some-
what swollen, the breathing was free, and he ex-
pectorated a good deal of mucus with his cough ;
the urine was turbid, high coloured, and scanty,
the skin hot and dry, the pulse frequent, full and
hard. Dec. Alth. cum Ammon, mur. et Roob
Sambuci was given, and he was ordered to keep
quiet in his bed.
In two days (the 15th of December) a branny
sediment appeared in the urine, the swelling of
the feet increased, and diarrhcea came on ; Inf-
Rad. Arnicae cum Ammon, mur. gr. xv. was now
given, and a blister laid between the shoulders.
On the 18th, the scrotum was very oedematous, the
urine less in quantity, the skin always dry ; warm
cloths were applied to the feet, and dry bags to
the scrotum, and Inf. Rad. Levistici cum Liq.
Ammon, acet. et Oxymell. simp, was given. With
the use of these remedies the swelling of the feet
and scrotum subsided, as also that of the glands.
To allay the cough and remove the abundant
mucous expectoration, his medicines were changed
for Decoct. Polyg. amar. et Lichenis. On the
20th of December he went home quite free from
complaint.
This patient’s case became interesting from an
occurrence which caused him to return in a fort-
night. Evident marks of crisis had not appeared,
and it was believed that the disease had termi-
c: 212 :]
nated by resolution ; however, some days after
his leaving the hospital, a swelling made its ap-
pearance in the right ham, which soon acquired
the size of the fist, was very painful, red, and
fluctuating. Emollient cataplasms caused this
critical abscess to burst, and an uncommonly great
quantity of matter vvas evacuated from it, after
which he completely recovered, and now enjoys
good health.
FEBRIS INFLAMMATORIA NERVOSA CUM IRRITA-
TIONE CEREBRI ET PECTORIS.
An inflammatory nervous fever wilh irritation
of the brain and chest, occurred in a stout young
maid-servant, nineteen years old, who was ad-
mitted on the seventh day of the disease. There
was a circumscribed redness and fulness of the
face, the head was hot, with stupor, tinnitus, ver-
tigo, and occasional delirium ; the eyes glassy, and
as if bathed in water ; the tongue dry, red, and
cracked ; she was very thirsty and complained of
a pungent pain about the false ribs of the left side,
which was increased by coughing, the urine was
red and cloudy, the skin quite moist, the pulse
frequent, rather hard and contracted. Ordered,
Dec. antiphlog. emollient cataplasms to the chest,
and six leeches to be applied to the forehead.
These relieved in some measure the headache
and stupor ; this, however, was not lasting, for
on the following day she was much as before, and
had a violent exacerbation in the evening. Six
leeches were in consequence applied to the tem-
ples, and glysters administered ; with this anti-
phlogistic treatment, notwithstanding the nervous
appearances, and the increased irritability and
sensibility ; the pains of the head and delirium
C 213 ]
abated, the circumscribed redness of the cheeks
vanished, the eye became clear, the tongue moist,
and a branny sediment separated from the urine.
For some time the Dec. Althsese was alone given,
she recovered perfectly, and after thirteen days
left the clinical school. The nervous character
of the fever did not deter us, in consideration of
the prevalent irritation of the brain and chest,
from adopting throughout a moderately antiphlo-
gistic treatment,
FEBRIS CATARRHALIS CUM AFFECTIONE
BRONCHIORUM.
A catarrhal fever, which happened in a young
woman, twenty-six years of age, was deserving of
notice from the afiection of the bronchia and con-
vulsive cough ; she believed that she took cold by
going through water barefooted in severe weather.
She had been suffering already three weeks with
cough, which had now so far increased as to oc-
casion vomiting during its attacks, in which she
became breathless and totally exhausted. She
had a sense of irritation and tickling where the
trachea bifurcates, with tightness under the ster-
num ; she had a dull pain in the forehead, coryza,
her speech was altered, the eyes painfully affected
by the light, and bathed in tears ; she could not
make a deep inspiration without bringing on a vio-
lent fit of coughing ; there was a mucous expecto-
ration, the heat of the skin was greater than na-
tural, the pulse very frequent, oppressed, and
rather hard. She took Dec. Alth. cum Pot. nit.
et Syr. Alth. ; leeches and emollient cataplasms
were applied to the upper part of the sternum,
which gave great relief, but had little effect upon
the cough, which lasted many days with great vio-
L 2U 2
lence. Blisters had little effect, and calomel was
next given in doses of half a grain thrice in the
day. A spontaneous epistaxis came on, which
was very serviceable ; but it was not till one sixth
of a grain of opium was added to the powders that
the cough became materially relieved ; she began
to perspire freely, and this removed the coryza.
Afterwards we had recourse to Plummer’s powder,
and the urine began to separate; the expectora-
tion was thick, globular, and truly critical, and
after each excretion of it she felt herself much re-
lieved. The bleeding at the nose recurred once
more. She entirely recovered w'ith the use of
Dec. Alth. cum Extr. Hyoscyami. A pleurisy
which a maid-servant brought on by a fall on her
left side, required bleeding ; the repeated appli-
cation of leeches and cataplasms, and inwardly,
emollient remedies w’ith nitre, to effect a resolu-
tion and cure. She was discharged well in eleven
days.
ANGTNA MEMBRANACEA.
A violent case of the above disease was admit-
ted on the 17th of December ; a deaf and dumb
boy, nine years of age, who was quite well in the
morning of the preceding day, at noon dined with
appetite, in the evening had shivering with sub-
sequent heat, great lassitude, and hollow cough.
The disease soon acquired such vehemence that,
according to his teacher, nothing less than suffo-
cation could be looked for. In the morning of
his admission, he complained of pains in the head,
and violent darting pain about the larynx, which
was increased by pressure ; a cough with a pecu-
liar sound at the same time came on, and with
such violence, as to threaten suffocation ; his
c: 215 ]
breathing was very laborious, accompanied with a
hissing noise, deglutition was not impeded, the
face puffed up, and red, the pulse very rapid,
somewhat hard, and oppressed. Six leeches
were immediately applied to the throat and the
bleeding encouraged, emollient cataplasms applied
to the neck, a blister between the shoulders, and
mercurial frictions to the sides of the neck and to
the breast; inwardly, Decoct. Alth. mannat. and,
from the urgency of the symptoms, powders con-
taining two grains of calomel, were ordered every
two hours. At the evening visit, considerable
amendment had taken place, but the pain conti-
nued, as well as the barking cough, and the fever
was still violent. Four moi’e leeches were applied,
and the other remedies diligently administered ;
he passed a better night, and slept between whiles,
his cough was less frequent. On the morning of
the 19th, his look was quite different, the counte-
nance more serene, the redness and fulness of the
face lessened, the paintrifling, the cough softer and
without the barking noise, the fever moderate, a
branny deposit had already appeared in the urine,
the skin was moist, he had had two stools. The
powder'was diminished to one grain every two hours,
to continue his other remedies; towards evening
the heat was considerably increased, and the pulse
frequent, but the cough was mild and moist ; nitre
was now added to the Decoct. Althaeas, the dose
of calomel lessened, and at length discontinued,
as the local complaint gave way. On the
at night, the urine again separated, and threw
down a sediment. lie left the hospital cured on
the tenth day.
A rheumatic fever, with an inflammatory affec-
tion of the intercostal muscles occurred in the case
i: 216 3
of Agnes Kopriwa, a servant-maid; from exposure
to cold she was seized with shivering and subse-
quent heat, with lassitude, soon followed by dart-
ing violent pains in the head, which extended
over the right side of the neck backwards towards
the false ribs, and were increased by pressure.
Quiet and warmth in bed, united to emollient di-
aphoretic remedies, as Decoct. Alth. nitros. cum
Roob Sambuci, Cataplasms, and dry warm cloths
to the neck, soon brought about relief and a per-
fect cure ; in eight days lime she recovered and
was discharged.
On the 21st of December, the following case
occurred in a nurse : After a momentary sense
of indisposition, which soon passed off, she fell
about noon lifeless, and in a state of insensibility,
to the ground, and more than an hour elapsed
before she was brought about ; the pulse was
moderately frequent, the respiration slow, not
impeded, the hands contracted with spasm. Aro-
matic vinegar, the besprinkling and washing with
cold water, as also frictions were of no avail, but a
sinapism to the prascordia and glysters, restored
her to life and consciousness. She made known
that she had been four days without alvine evacu-
ation, which she had usually daily. She had
scarcely spoken when she was attacked with fresh
spasms and convulsions, even with symptoms of
opisthotonus. Glysters, with Inf. Anthem, and
muriate of Soda were given ; also, Aq. Menth.
Meliss. a Tinct. Castorei Liq. Ammon. Suc-
cinnat, a ^ss ; and moreover, a dose of sulphate
of magnesia ; some stools soon followed, when the
spasms and other morbid symptoms shortly dis-
appeared.
: 217 3
PTYALISMUS.
An old woman, who lodged in a close apart-
ment with a barometer-maker, fell into a violent
ptyalism, in consequence of his having employed
a good deal of quicksilver for some days. The
few teeth she had were so loose, that she could
move them any way without difficulty, two of them
came out, the mouth was full of aphthae, the gums
and tongue swollen, and as she expressed it, her
mouth burned like fire ; the saliva flowed abun-
dantly, and her breath was most offensive ; she
could scarcely take any food, even soup caused
much pain. Dec. Gram. cum. Sodae sulph., and
powders with sulphur sublim. were given ; emolli-
ent warm collutoria was ordered, and which soon
gave her relief. By degrees, with this treatment,
all the symptoms disappeared, but the teeth from
want of gums did not fasten ; after the inflamma-
tory stage, the continued use of Infus. flor. Salviae
was of great service. A proof of the powerful
effect of quicksilver on the human frame.
PERIPNEUMONIA.
A very violent, but regular and shortly termi-
nating inflammation of the lungs happened to a
stout brewer’s apprentice, who brought it on by
exposure to cold. The expectoration was very
much coloured with blood, the affection of the
chest, oppression and'pain as well as cough, were
violent; he could not lie on the right side, nor
make a deep inspiration, the pulse was somewhat
hard and strong. A copious bleeding gave great
relief, yet the expectoration was still bloody, and
only on the following day began to disappear, as
did also gradually the fits of suffocation. Emolli-
u
C 218 3
ent remedies, as althaea with nitre, cataplasms, and
a strict diet, were very conducive to his recovery,
and in eight days he regained his former health
and left the hospital. Among the remaining cases
which came into the sick wards, one of apoplexy
deserves notice.
A cooper fell senseless from his bench, and was
brought on the day following into the general
hospital. The cause was unknown, he had led a
regular life, and was now in his seventieth year.
Paralysis had taken place on the left side, blood-
letting, purgative remedies, and stimulants to the
skin, had effected no relief ; he died the second
day after his admission. When examined, an ex-
travasation of six ounces of blood was found in
the right lateral ventricle of the brain, which so
distended that cavity, that on exposing the brain,
a remarkable protuberance on its surface was ob-
served, and the ventricle itself had burst. The
extravasated blood was from the plexus choroides
of that side which was beset with hydatids, and
its veins were varicose.
JANUARY.
Bar. Ther.
Highest 29.093 44. 6.
Lowest 27.549 17.37
Mean 28.321 30.98
Winds very variable.
January set in with foggy, but mild weather,
the little snow which fell disappeared.
After the 6th, clear weather came on with in-
ci’easing cold, and the barometer rose to a great
height. Earthquakes took place in several parts
of North Germany. The prevailing diseases were
C 219 ]
catarrhal and rheumatic fevers, acute gout, erysi-
pelas and dropsies ; few cases of inflammation
confined to particular organs, happened in this
month. The treatment adopted in rheumatic
fevers, was the antiphlogistic with gentle diapho-
retics. In inflammatory gout, mild diaphoretics
with small doses of nitre, after enveloping the
affected part with tow, and the employment of
local bleeding where the violence of the disease
seemed to require it.
BRONCHITIS AND TRACHEITIS.
A remarkable case of inflammation of the tra-
chea and bronchia occurred in a washerwoman,
by name, Franciska Kopetzka, aged twenty-five
years, and of tolerably stout habit of body. She
had been subject yearly, since her twenty-third
year, to a nettle rash which receded, and for
which this year she had taken, by the advice of a
woman, some remedies which had brought on
violent vomiting and purging, so as to reduce her
considerably. A dry cough which came on, and
which she considered as the effect of taking cold,
induced her to make use of saffron steeped in
brandy. After which she began to cough violently,
had great oppression at the chest, short breathing,
alternate heat and cold, with headache and in-
creased thirst : these symptoms acquired, in a
short time, viz., from early in the morning till even-
ing, such violence, that she was thi’eatened with
suffbcation every minute, she lay breathless and
senseless after each fit of coughing. She was
brought into the clinical hospital in this state
at ten at night on the 25th of November. She
gasped for breath, could not articulate, nor even
produce any sound whatever ; when the cough
C 220 3
came on she grasped at the nearest fixture to steady
herself and get breath ; she could only bear to be
in the erect posture, and with inexpressible anxiety
she begged with her uplifted hands for relief; the
eyes were prominent, she felt a violent burning
pain in the course of the trachea, and an oppres-
sive tightness at the chest; she could not breathe
deep without bringing on a distressing, painful,
hollow, barking, and dry cough, and spasmodic
contractions of the hands, which placed her in
imminent danger of sufibcation; her ordinary res-
piration was much impeded, attended \vith an un-
usual sound; when she coughed, she also felt
temporary sharp pains in the left side ; the abdo-
men was free from pain, the pulse small, and so
oppressed as to appear thready, and could only be
felt by great attention. Ten ounces of blood were
taken, and six leeches applied to the trachea,
emollient cataplasms to the breast ; inwardly. Mist,
oleosa; Calom. gr. j. et Ext. Hyosc. gr. ss. every
hour, and a mild pectoral linctus were ordered.
The blood as it flowed in a full stream seemed to
restore the patient to life; she could now make a
deep inspiration, and the sufiocating fits of cough-
ing became immediately milder ; she had a much
better night. On the following morning she found
herself much better, the cough was both less fre-
quent and less violent, nor was it any longer so
hard and hollow, the pain and oppression of the
chest had also ceased ; only in the course of the
trachea she yet coin])lained of a burning pain and
inclination to cough ; her voice had returned,
though hoarse; her bi’eathing more quiet and free,
the ]iulse frequent, rather hard and compressed,
yet much more free than yesterday; the blood had
a thick inflammatory coat. Four more leeches
c: 221 :]
were this day applied to the trachea, the rest con-
tinued, except that the calomel was reduced to
half a grain.
On the 27th, the pain in the trachea had dis-
appeared, a rawness and tickling remained, the
cough was softer, and she already spit up a thick
globular expectoration with great relief ; her
breathing became more free, she could recline
easily in any posture, the pulse was moderately
frequent, more free and strong ; she had several
loose stools, hence the calomel was laid aside,
and the emulsio gummosa ordered. But as on
the day following, the 28th, the diarrhoea conti-
nued, and rather increased, the Dec. Salep. spiss.
cum Syr. Papav. was given instead of the Emuls.
Gummos. and also powders with a third of a grain
of Ipecacuanha every two hours. A white sedi-
ment shewed itself in the urine, the diarrhoea sub-
sided, the cough and other complaints ceased, her
voice became natural ; and with the use of Dec.
Salep. spiss. in eleven days she regained her
health.
urticaria;
On the 7 th of December, a striking case of ur-
ticaria presented itself, in a stout plump maid-
servant, by name Fransiska Popp, twenty-three
years of age ; she could not assign any cause, but
was on the 4th of December taken with shivering,
which was followed during the night by a violent
burning of the skin, as though she had lain on
fire ; she was very hot and thirsty, and remarked
the following morning, here and there on the skin,
particularly on the extremities and breasts, pale
and deep red vesicles and spots, the former raised
above the skin, and having a great resemblance to
u 3
C 222 2
those raised by the application of nettles; she felt
some oppression at the chest, had a cough, and
had been costive for some days. Ordered, Dec.
Alth. cum Pot. nit. et Roob Sambuci ; and as on
the following day the bowels did not act, Sodae
Sulphas was substituted for the nitre. The erup-
tion began in part to disappear on this day, and
on the 9th a separation of the cuticle was ob-
served ; she soon got well, and left the hospital on
the 1 3th of December.
ARTHRITIS.
Acute arthritis occurred often in this month :
with regard to the treatment, arthritis acuta, and
rheumatismus acutus, W'ere very similar ; both were
treated as inflammatory affections, in which our
attention was particularly to be directed to the
perspirable state of the skin. Gramen, Althsea,
nitrum, neutral salts, and keeping the aflected
parts warm, almost made up the treatment; to
which w'ere joined, only in cases of greater vio-
lence, bleeding (chiefly topical), and after that the
inflammation w'as removed but the pain remained,
blisters, dulcamara, aconitum, antimonialia, and
calomel. The numerous cases which occurred, in
our school at least, were thus speedily and fortu-
nately cured without one unpleasant instance of
metastasis. In proof of which some cases shall
be stated.
Mathias Gross, a button-maker, twenty-nine
years of age, born of healthy parents, and having
always enjoyed good health, about two years since
was attacked with general pains of the limbs, of
which he was cured by blood-letting and anti-
phlogistic remedies. He continued well till, on
the 10th of January this year, he fell into the same
[ 223 3
disease, and which, as he believed, was brought
on by working a good deal in the damp ; he had
violent pungent pains in the knee and ankle joints,
could not walk or mov'e his feet; his elbows, wrists,
and fingers of both hands w’ere now' attacked; all
motion painful, or denied him.
A vveek passed thus before became into the
hospital, he had a good deal of fever, and his face
was distorted with pain; the above joints, and now
even those of the shoulder w'cre swollen and pain-
ful, particularly on motion, the thirst great, the
pulse quick and full. The joints were wrapped
in warm tow, and he w'as ordered diaphoretic and
opening medicines, as Dec. Gram, cum nitro ; vel
Sodae Sulph. et Roob Sambuci, and to be kept
warm in bed. An universal, abundant, vaporous,
sour-smelling sweat and gentle stools took place,
the pains in the joints by degrees subsided, and
the power to move returned in proportion; after
a fortnight he was quite free from complaint, and
returned home to his occupation quite well.
A very similar case happened to a widow, fifty-
eight years of age, and also to a maid- servant,
twenty-two years old, who had not before suflPered
from this disease. The same symptoms required
the same remedies, and the disease was fortunately
terminated in a regular way, by abundant perspi-
ration of a very sour smell, and a sediment in the
urine ; they were both soon cured. This disease
attended with the above symptoms does not bear
stimulant remedies, and the diaphoretics used
must be entirely taken from the antiphlogistic
class, even Liq. Ammon, acet. and Dulcamara,
do not succeed at first, still less Aconitum ; but it
cannot be denied but that when the fever is sub-
dued, and the pains continue, these remedies are
C 224 3
very appropriate. In the above cases we had no
occasion for them. Apoplexies and palsies occur-
red frequently, and at the same time in this month,
the latter generally a consequence of the former :
it was remarked, that when they appeared the ba-
rometer underwent great changes; for from an
unusually depressed state, it rose suddenly to an
uncommon height. The conditions of the atmos-
phere appeared evidently as the chief cause, but
of what kind, and in what they consist, is a ques-
tion not yet to be satisfactorily answered. The
persons attacked were, for the most part, men of
from thirty to fifty years of age, and of various
occupations. Paralysis was more generally on the
right side, which extended even to the oesophagus,
whence difficulty of swallowing, but without pain ;
or to the larynx, whence stammering, and scarcely
intelligible speech ; if to the muscles of the face
of one side, a distorted mouth ; if to the rectum,
difficulty in going to stool, but without pain ; great
costiveness; if to the muscles of the extremities,
paralysis of the muscles of the side affected. The
treatment when inflammatory symptoms appeared
was antiphlogistic ; bleeding, cupping, stimulants
to the skin, and eccoprotic medicines were first
employed, afterwards Flores Arnicae, Rad. Senegae,
Pyrethrum, Liq. Ammon, carb. et anisat, Nux
vomica, aromatic frictions, vapours, and baths
with soap lees. In many tedious cases, the gal-
vanic pile was attended with the desired effect,
and which succeeded when the above treatment
failed.
: 225 3
FEBRUARY.
Bar.
Ther.
Highest. . .
29.072
47.75
Lowest. ...
. . . .27.776
20.75
Mean
28.424
34.25
Prevalent winds, north-west and south-west.
The mildness of the winter of this year extended
into February, in which were many warm days ;
but towards the middle, cold north winds and
snow storms prevailed ; after the 20th it became
cloudy, and the air was moist but not very cold. In
consequence of this state of the weather in this
month, frequent colds and other catarrhal com-
plaints prevailed, as well as gout and rheumatism ;
notwithstanding which, the fevers that occurred
had the nervous character, to which the mild
moist weather, and the earth bereft of snow, and
free to exhale, mainly contributed ; to these may
be added atmospheric influence, less understood.
Nevertheless, this character continued with the
already detailed symptoms in a milder form ; and
it appeared evident that it was notin general joined
with a deficiency or depression of the vital powers,
but that they were in sufficient force. The pulse
was in the beginning, as regarded its frequency
and strength, always such that one would have
prescribed any thing rather than stimulants, but
the more decided antiphlogistic, or even evacuat-
ing plan, were as little to be ventured on; so that
it became the physician’s duty to act the part of a
quiet observer, and let nature take her course,
which was often fortunate.
c: 226 3
CATARRHUS NARIUM EX POLYPO EVULSO.
A remarkable case of coryza occurred in a
young woman, twenty years old, and of a tender
habit of body, who, for some years, had suffered
from nasal polypi, several of which had been ex-
tracted at different intervals. She had, indeed,
undergone the operation within a month of her
admission into the hospital, after which she went
some distance home in bad weather. The pains
occasioned by the extraction were not of any con-
sequence ; but in the following days they so much
increased that, with shivering, subsequent heat
and lassitude, she was forced to take to her bed.
A dull heavy pain, which occupied the whole fore-
head, and proceeded from the root of the nose,
over the left cheek, to the zygoma, distressed her
without intermission.
When she came under our care, these pains
were so violent, that she could not rest in any
posture ; could scarcely open her eyes, or bear the
light. The conjunctiva was inflamed, the eyes
suffused with tears, the countenance swollen, the
cheeks, as well as the mucous membrane of the
nose, as far as it was visible, were red ; she had
an unpleasant sense of dryness and tension in that
part, the degree of fever was not proportioned to
the violence of the local suffering ; the pulse was
moderately frequent, soft, and full. Leeches were
applied to the temples, and a blister to the neck ;
she took Dec. Alth. cum Roob Sambuci, and had
glysters injected. She was immediately relieved
by the leeches, the headache disappeared, and, in
a few days, she went to her home.
i; 227 3
PHTHISIS PULMONALIS.
A case known in practice, viz., that during preg-
nancy consumption is suspended, appeared in a
woman, who was brought in her ninth month, in a
tolerable state, having only a cough, attended with
puriform and rather copious expectoration, but
without any difficulty of breathing. She had a
good time, and was tolerably well for some days
after delivery ; but now the disease, hitherto mild,
came on with renewed force, the cough became
troublesome, the expectoration was abundant, and
of an ichorus character, colliquative sweats, with
increased fever, daily increasing emaciation and
weakness came on, and in a few weeks she died.
On opening the body, the lungs were found
attached to the ribs, and so degenerated into a
sanious cancerous mass, (carcinoma pulmonum)
that the knife, in cutting them, met with the resist-
ance which one finds in dividing a cartilaginous
substance ; and yet her pregnancy had been able
to suspend, for a time, this extensive disease.
EPILEPSIA.
A disease against which medicine often strives
in vain, viz., the epilepsy, occurred in a student,
twenty-two years old, who had always enjoyed
good health, and whose parents had not been
subject to this disease. He dined one day with a
good appetite, but afterwards felt himself unwell,
and had nausea. In about three hours he had a
complete epileptic paroxysm ; he fell into a state
of unconsciousness, saw and heard nothing ; those
who were present told him that he was seized with
convulsions, had foamed at the mouth, and after-
wards fallen into a profound sleep: this attack
i: 228 3
recurred the same day, after a short interval.
When, on the day following, he came into the
hospital, he had the fits as above described ; the
countenance was at the time very much puffed, of
a livid red, and continued so after the attack ; the
expression of his countenance was changed, the
white of the eye red, with extravasated blood, the
eyes protruded, the tongue swollen, and bitten at
the apex and sides — it was white ; he had a bitter
taste and increased thirst, the head hot to the leel,
and heavy, the determination of blood to it could
not be mistaken ; there was a sense of pressure at
the praecordia, the bowels lax, the pulse quick, lull,
and somewhat hard. The mistura temperaos (ex
Potass, supertart, et Test, prmp.) and powders,
with a grain of Zinci. Oxyd. were given, some
leeches were applied to the temples, and cold ca-
taplasms to the head, together with sinapisn^ to
the calves of the legs. Afterwards he took Dec,
Gram, cum Sodae Sulph. et Ant. tart. gr. j. ; con-
tinued the powders, and observed a strict diet.
The paroxysms soon appeared as mere threaten-
ings; he had spasms, with continued conscious-
ness, the head became more clear, the tongue
cleaner ; with the use of Dec. Gram, cum Potass,
tart, he was in a few days freed from his complaint,
and went home to resume his studies.
SPLENITIS.
An old woman, in her sixtieth year, the wife of
a distiller, who often had recourse to a glass of
brandy, was seized with violent pains in the helly,
for which she was admitted into the hospital. All
the symptoms denoted an inflammation of the
spleen, which was attended with much fever ; she
was treated accordingly ; she was bled, and the
C 229 ;]
other antiphlogistic means adopted. She improved
according to our wishes; the local sulFering di-
minished, the enlargement subsided, she could
more easily bear pressure, and a sediment also
appeared in the urine ; still the fever did not en-
tirely leave her, and a degree of tenderness, which
soon increased, i*emained about the spleen, the
pains even extended themselves more towards the
pit of the stomach, and a periodic suffocation and
vomiting came on, but not from having taken food ;
to this was added a difficulty in making water, she
felt a burning sensation, and could only void her
urine by violent efforts, and the pains extended to
the region of the left kidney ; in short, all the cir-
cumstances gave reason to fear a concealed inflam-
mation of the stomach and kidney, to which her
former habits of life seemed especially to contri-
bute. A slow fever came on, the occasional vo-
miting could not be allayed, the secretion of urine
became less, and dropsy was forming. This was
fortunately averted, but there was still a continu-
ance of the fever, of the pain in making water, as
well as of that about the stomach, spleen, and
kidney. Leeches, emollient mucilaginous reme-
dies, emulsions, mercurials, frictions, sinapisms,
cataplasms, and baths did indeed somewhat re-
lieve, but could not effect a cure ; and after seven
weeks sbe died.
On examination, the cavities of the head and
chest presented nothing uncommon. In the abdo-
men, the intestines were of a natural appearance,
the liver adhered to the neighbouring parts, and
was uncommonly firm in its texture ; the left lobe
formed the upper side of an abscess, which ex-
tended from the cardiac portion of the stomach,
and, on a nearer inspection, the upper part of that
X
c: 230 :]
viscus was found cancerous and eroded. Lympha-
tic exudations were observed on the surface of
the spleen, which clearly proved the previous in-
flammatory state of this organ ; its structure was,
however, natural, only much enlarged ; the left
kidney was greater by one-half than the right one,
not diseased in its texture, but in the pelves of
both there were several steatomatous substances,
the size of a walnut. In the coecum were several
thread-worms. This inflammation of the spleen
was the mere consequence of the original morbid
state of the stomach, in a part where it is imme-
diately connected with that viscus, and into which
the vasa brevia could not, by reason of the schir-
rous formation, empty their blood ; inflammation
of the spleen was also a consequence, and though
the cure of this, the more conspicuous disease, was
effected, the termination could not be favourable,
from the organic mischief in the stomach.
It was, however, singular that she should not,
at a more early period, have had difficulty in
making water ; for this affection of the kidney
could not be of recent date. Her former habits,
and excess in drinking brandy, were most proba-
bly the cause of the schirrous state of the stomach.
MARCH.
Bar,
Tlier.
Highest . . ,
, . . .28.857
Lowest . . . .
. . .27.606
23. 9
Mean
...28.261
4-1.22
The north-west was the most prevalent wind.
The beginning of this month was stormy, with
drifted snow, prevalent east wind, and a depressed
state of the barometer. About the middle, mo-
L 231 3
derately warm weather with rain, set in, after
which it changed, and became cold ; towards the
end we had clear cool weather. The prevalent
diseases were rheumatic and gastric fevers, and
intermittents, attended chiefly with gastric symp-
toms ; some cases of inflammations of the chest
and liver, besides which the nervous febrile type
continued, but it was now accompanied with fre-
quent inflammatory affections of the chest and
abdomen. It required a mild observant practice,
with constant attention to the local complaint, and
which often rendered the employment of leeches
indispensible.
The following case aflfords a fresh proof of the
truth of that doctrine, which enjoins us to be cau-
tious in the use of stimulating remedies in fevers
of a nervous type, and not to interrupt the salu-
tary efforts of Nature : —
FEBRTS NERVOSA CUM CATARRHALI ORTA.
JohnFliegel, ten years old, a school -boy, caught
cold about the end of January, he felt a constant
chilliness, and an oppressive dull pain in the fore-
head. This was quite neglected. On the 13th
of February, a violent shivering, and burning heat,
with thirst and lassitude, came on ; as also a dry
cough and diarrhoea. Many days elapsed, and he
was brought on the 25th to the general hospital.
He complained of a dull pain of the head, and ver-
tigo when he raised himself in bed ; his look was
pale, the tongue covered with a dirty yellow coat,
his taste bitter, his breathing free, occasionally
attended with a raw dry cough, the belly soft, the
loose stools continued, of which he had several
during the day, the skin was dry and hot, the
pulse frequent, and rather weak. Ordered, Dec.
c: 232 ;]
Salep. spiss. cum Ammon, mur. et Syr. Papav.,
and a blister between the shoulders. As the dis-
ease continued, there appeared, on the 28th, pe-
techias, like bluish-red spots over the m hole skin, he
felt himself in other respects the same. The stools
were less frequent, the pulse soft and small. Pow-
ders, with one-third of a grain of Ipecacuan and
Infus. Arnicas cum Aq. Cinnam. et Mucilag. Aca-
ciae were now given. On the 1st of March, the
petechias disappeared, and he was in all respects
better ; the countenance more cheerful, the skin
passed into a vaporous sweat, the urine became
clouded, the stools were natural. In consequence
of the cough returning, he took Dec. Salep., and
afterwards Dec. Polyg. amar., and, lastly, Infus.
Rad. Caryophyllat. He left the hospital quite
well on the 25th of March,
ARTHRITIS ACUTA GENU DEXTRI IN FUERPERA.
A stout countrywoman, eighteen years old, came
to be delivered in the city. She travelled in the
month of December in an open carriage, and was
exposed, in the coldest weather, to all the incle-
mency of a wet and cold winter’s blast. M et to
the skin, she had already felt in her journey
sharp pains in her right knee and shoulders,
shivering, and subsequent heat. She was brought
to bed on the 21st of December, the day after her
arrival, of a dead child ; her delivery had nothing
else uncommon. The pains in the knee-joint be-
came worse daily, so that on the 23d, she was
brought into the clinical hospital. There was a
violent inflammatory fever, with extreme pain in
the shoulder-joint; the breasts had no milk, the
lochia were in sufficient quantity, the right knee
much swollen, hot to the touch, but not red; it
c 233 :
gave her the most violent pain, which was insuffer-
able during the night, the least motion caused her
to shriek, and the slightest pressure could not be
endured.
Leeches were several times applied to the knee,
and it was enveloped in dry cloths, but from the
violence of the pain, they were changed for an
emollient anodyne poultice ; she took Dec. Gram,
cum Sodae Sulph. et Roob Sambuci. The pains
of the shoulder soon disappeared, but those of the
knee continued with such obstinacy that fears were
entertained lest they should terminate in a white
swelling, loss of motion, and other disoi'ganization
of its structure. As it was merely inflammation of
the parts surrounding the joint, particularly of the
tendinous and fibrous structures, which caused the
violence of the disease, so at different intervals,
as the violence of the pain recurred, about fifty
leeches, and several cupping-glasses, with scarifi-
cations were applied about the knee, land repeated
sinapisms and blisters ; mercurial, and, lastly, the
tartar emetic ointment, rubbed in. The scarified
parts began now to suppurate, by which the pain
diminished, and the tumour subsided ; if they
healed, blistering plaster was again applied, so as
to restore them ; at the same time, mercurial
frictions to the leg, poultices to the knee, and,
inwardly, derivative and alterative remedies, as
Potass, tartras, Calomel, Antim. Sulph. praecip. ;
and Aconitum were administered ; so that this
painful and obstinate disease was subdued in
about ten weeks. An anchylosis spuria of the
knee remained, which was removed by mercurial
friction, emollient cataplasms, and prudent motion
of the limb. She left the hospital on the 15th
X 3
f
L 234 ]
of March, after an unusual degree of pain and
suffering.
PLEUROPERIPNEUMONIA.
Josepha Schwalb, forty years old, a nurse, of
weakly habit of body, was seized with a violent
inflammation of the lungs and pleura, for which
she was bled at home. On the second day of the
disease she came into the clinical hospital ; there
was great heat and thirst, a violent stitch, and
oppression of the breast, which was increased by
a continued dry cough, or a deep inspiration ; the
pulse was frequent and hard. She was again
bled, the blood was buffy; she had besides emul-
sio nitrosa, and emollient cataplasms. On the
fourth day, the urine shewed marks of a crisis, and
she was in general better. AYith the use of Dec.
Althasse, and an emulsion, with Ext. Hyoscyam.,
she soon regained her former health, and was
discharged on the eighth day.
FEBRIS INTERMITTENS TERTIANA.
Intermittent fevers were not uncommon with us,
either in the present or the last year, but they
were generally mild.
Adalbert Hawlik, eighteen years old, came into
the clinical ward with the symptoms of a synocha
gastrica, which he had brought on by errors in
diet. He was treated with antiphlogistic laxative
medicines, and was soon better ; the tongue be-
came clean, the taste natural, and the appetite
returned. Scarcely convalescent, he was seized
one day, without apparent cause, with violent
cold, thirst, and subsequent heat, which ended in
sweat ; the urine threw down a brick-coloured
i; 235 3
sediment ; after these symptoms were gone off,
the patient found himself quite well again. He
went on with the Dec. Gram, cum Ammon, mur.,
and, after the fifth paroxysm, the bark was given
in substance, gr. xv. every two hours. After he
had taken an ounce the paroxysms ceased, and
he left the hospital in three weeks quite well.
Another case of tertian fever occuiTed in a
mechanic, by name Charles Shonel, who, six
weeks before, had got it when travelling. He
too appeared to have had derangement of the
primae viae as the cause; the bowels had been
for some days costive. Dec. Gram, cum Sod.
Sulph. was given ; afterwards Dec. Tarax. cum
Ammon, muriat. ; and, lastly, a mixture with Ext.
Centaur, min. cum Sp. yEth. sul. comp.; and with
these remedies he got well in ten days without
having recourse to the bark.
VITIUM CORDIS.
A shoemaker, fifty years old, was afflicted with
a chronic affection of the heart ; an enlargement
of the left side of that organ was probably the
cause of his disease, which was manifested by
extraordinary palpitation, a very irregular pulse,
dyspnoea, oppression, short breath in going up
stairs, and vertigo. He had been ill for two
years, before which he had the piles, and could
not recollect any decided cause of his complaint ;
he was already greatly emaciated. Absolute rest
was recommended, and cooling laxative remedies
were given — as Dec. Gram, cum Potass, super-
tart. et Aqua Laurocerasi ; he was also cupped
in the loins. This simple treatment, to our asto-
nishment, had the most desirable effect j the pal-
pitation and oppression diminished, the pulse
C 236 -2
became more free, the patient gained flesh and
strength, and, happy in having obtained such
unexpected relief, desired, in this amended state,
after three weeks to return to his family.
APRIL.
•
Bar.
nier.
Highest . . .
. . .28.936
Lowest. . . .
32. 9
Mean
. . .28.392
56.63
The beginning of April was raw and stormy,
with drifting snow, but the sky soon became se-
rene and clear. About the middle of the month
it was cold and frosty, at the end it became warm
again, and favourable to vegetation.
The catarrhal was the prevailing character of
disease, and which readily passed into the sub-
nervous state, of a mild nature. Intermittents
also occurred frequently, for the most part ter-
tians, with gastric affection, which yielded without
difficulty to the evacuating mode of treatment,
followed by the bark.
The uncertain changes of the weather, with
the continued moist and cold air, gave rise to
rheumatic fevers ; and gouty subjects had vio-
lent attacks, which were attended with inflamma-
tion, and required local bleeding.
The nervous type required throughout a mild
treatment, and even in bad cases did not bear a
bold exciting sort of practice; for there were
frequently connected with it symptoms of chronic
inflammation of the abdominal viscera, which, as
the cause of the greatest danger, required par-
ticular attention, and called for a modified, emol-
lient, soothing practice, and the derivative mode
of treatment.
i: 23- 3
ANGINA TONSILLARIS.
Several cases of angina occurred in this month,
one of which was that of a cook, who got it by
exposure to cold : the deglutition was impeded,
the parts about the fauces were very red and much
swollen, particularly the tonsils, which were felt
outwardly as hard painful tumours; there was also
considerable fever. With the use of leeches, poul-
tices to the neck, and gargles, and inwardly, Dec.
Alth. cum Potass, nitrat. 9j, the symptoms yielded
in a few days ; a headache, which remained, was
removed by a blister applied to the neck, A very
similar case, in a student of surgery, was cured by
the same remedies, and in an equally short time.
PERITONITIS ET OOPHORITIS.
A remarkable case of peritoneal and ovarial in-
flammation presented itself in a maid-servant ; she
had been six weeks before delivered with the
forceps, and had soon recovered, but caught cold
on the 24th of March, and had pains in the abdo-
men. So long as they were not violent, she took
no care of them ; and it was not till the 30th that
she was admitted into the clinical hospital with
fever, dry tongue, and a fixed darting pain in the
region of the left ovary, which extended over the
abdomen, with a frequent and hard pulse; but
what was singular, she had a frequent and violent
hiccup, with which she stated herself to have
been troubled for two years. Leeches, emollient
cataplasms, mercurial friction, glysters, Dec. Alth,
mannat. and Calomel, subdued and removed all
the sym])toms except the hiccup. Half a grain of
Oxyd, Zinci was now employed every three hours
against this merely nervous symptom, and a sina-
c 238 2
pism was besides applied to the region of the
stomach, by which means this troublesome aflfec-
tion was entirely removed; she left the hospital
quite cured.
The scarlet fever appeared sporadically. A case
occurred in a female, twenty-three years old, which
was indeed of the miliary kind, but of a good cha-
racter ; it went off in a mild and regular way with
gentle antiphlogistic remedies. The patient re-
quired her dismissal on the fifteenth day, not-
withstanding our representations to the contrary,
as she had at home the opportunity of taking
care of herself, and keeping her chamber. She
went home, paid no attention to the regimen so
strongly enjoined her, and a general dropsy was
the consequence. She was now ordered to keep
in bed, and Dec. Gram, cum Potass, acetat. et
Oxym. Scillae was given ; a plentiful diuresis came
on, and the interrupted period of scaling was com-
pletely and fortunately finished.
METRITIS CHRONICA.
Chronic inflammations are a very abundant
source of various sufferings to which mankind are
exposed ; they are often with difficulty made out,
and their cure is still more difficult, for their
course is slow and imperceptible, and our art can
only oppose them with success by a treatment,
steady and long continued, antiphlogistic, and yet
not too active. Patience and perseverance are as
necessary on the part of the patient as of the
physician ; whence the moral treatment, which
keeps the sufferer in confident hope, is of the
greatest consequence. Their outset is almost al-
ways attended with such slight symptoms that the
patient scarcely notices them, they even escape
c: 239 ;]
the sagacity of the physician. They often begin
as acute inflammation, and afterwards assume the
chronic form ; this more especially occurs when
the organ which is attacked had been long before
in a disordered or irritable state.
A woman of the town, twenty-eight years of
age, of a sprightly temperament and middle sta-
ture, had twice, since her twentieth year, been
treated in the general hospital for inflammation of
the womb, and once for an haemorrhage of that
organ, both the consequence of her mode of life.
On the 3d of March she was seized with shiver-
ing and subsequent heat, pains in the loins and
lower part of the abdomen ; she endeavoured by
the use of chamomile tea to abate them, and re-
mained at home up to the eleventh day of her
illness ; but as her suflPering was not relieved, she
came into the clinical hospital on the 14th of
March, in the following state : — There was pain in
the head, the countenance was pale and hot, with
mai’ks of suffering ; the thirst great, the tongue
white, the breathing free, the abdomen tense,
attended with a darting continued pain in the
region of the uterus from the slightest pressure ;
she made water without difficulty, the bowels
open, though generally irregular ; she had occa-
sionally tenesmus and swelling of the hagmoi’rhoidal
veins, the pulse was moderately quick, contracted,
oppressed, and rather hard. The menses had not
appeared for about three months ; she said that
during this period she had suffered from occa-
sional but frequent attacks of darting penetrating
pains at the bottom of the belly, which she thought
were spasms. She was bled to seven ounces, and
emollient fomentations (as cataplasms could not be
borne) were ordered ; also Ol. Amygd. 5iij ; Mucil.
: 240 ]
acac. ; Syr. Alth. 5ss; Aquae distill, On
the day following the pains were diminished,
•the pulse was more free, the urine pale yellow,
she had had a stool. The disease remained in
this improved state till the 19th, when the pains
returned with violence, and more fever came on :
she was bled again to eight ounces, and took half
a grain of calomel three times a day. The violence
of the pains was with this considerably lessened,
but they were in proportion more continued, and
extended sometimes towai’ds the kidneys, at others
towards the sacrum; the fever was moderate, but
feverishness, especially towards evening, came on
with increased thirst, an excited and quick pulse,
the urine continued of a pale yellow colour, and
threw down a mucous sediment ; she continued
six weeks in this state, and evidently lost flesh.
With regard to the treatment, in the more violent
attacks leeches or cupping were used, when the
pain was not in the integuments but aflected the
inwai’d parts, emollient cataplasms and glysters,
mercurial friction and tepid baths, were also dili-
gently employed ; inwardly, Dec. Alth., Salep.,
Emulsions, Calomel, and Ext. Hyoscyami were
given, and a very light nourishing diet, consisting
merely of mucilaginous substances was ordered.
The pains, as well as the slow fever, in five or six
weeks (when also the menses appeared) gradually-
abated, and entirely disappeared in the seventh
week. For a fortnight she was taken good care
of as a convalescent; and on the !24th of May,
free from any trace of pain or complaint, she was
discharged, and advised to change her mode of
life.
c: 241 ;]
ENTERITIS.
A female, twenty-eight years of age, of a stout
make, and otherwise healthy, exposed herself to
cold by hanging out linen to dry. Soon after-
wards she was seized with violent pain in the
abdomen, with shivering and subsequent heat, for
which she was bled. She was somewhat better,
left her room, and though suffering, returned to
her occupation. As in three weeks time her
foimer pains returned with violence, a physician
prescribed a vomit; she thought herself relieved
by it, but the same pains soon returned with re-
newed violence, and spontaneous vomiting came
on. She now, in the sixth week of her disease,
applied for relief at the hospital.
The head was not affected, the eyes were clear,
the countenance pale, and indicative of pain, the
tongue coated, there was nausea, eructation, and
great thirst, the breathing free, the abdomen dis-
tended, with constant sharp pain, especially about
the navel, which did not admit of the slightest
pressure ; the heat of the skin moderately in-
creased, the skin soft, inclined to perspire ; she
had had no stools for two days, the pulse was
equal, frequent, contracted, and rather hai’d. Six
leeches were applied to the umbilical region ;
emollient cataplasms and glysters were also or-
dered. She took Dec. Althaeae mannat. After
the leeches she felt much relieved, her menses
appeared, yet, notwithstanding the glyster, no
evacuation took place ; three drachms of Mag.
sulph. were added to the mixture. She had
now some loose stools, the pains became less, the
belly admitted of pressure, the urine threw down
a reddish sediment, and soon acquired the natural
Y
: 242 3
colour. As the intestinal secretion was, during
the following day, again indolent, and as there
was no longer any pain, Dec. Gram, cum Potass,
tart, was ordered, and she left the hospital by the
12th of April.
MAY.
Bar.
Ther.
Highest. . . .
. . . .28.842
78.12
Lbwest. . . . .
16.25
Mean
....28.418
47.18
The prevailing winds were south-west and
north-west.
May did not bring with it its usual fine wea-
ther, being generally cold and rainy ; and the fre-
quent north winds made it ratv and ungenial.
The fevers changed now into the inflammatory
rheumatic type, yet without any remarkable de-
gree of violence ; and the nervous character al-
most entirely disappeared. There were frequent
inflammations of the lungs and pleura, and also
rheumatic and arthritic diseases ; also intermit-
tents; which last, within these two years, have
become frequent, though for ten years before they
might be considered as uncommon.
As the inflammatory character was in a mode-
rate degree, a mild antiphlogistic treatment, with
bleeding in small quantity, was sufficient: but
the inflammatory arthritis required, on the con-
trary, an energetic mode of treatment; repeated
local bleeding and cupping were found most
effectual; and violent pains could alone by this
means be alleviated, and entirely removed.
Intermittent fevers required laxative eccoprotic
remedies, and after a certain number of paroxysms
c: 243 3
they gave way easily to moderate doses of bark,
one or two drachms of which were mixed with
four ounces of spring water, and of this a table-
spoonful was given every two hours. From two
to four of these mixtures were generally sufficient
to effect a cure.
PERIPNEUMONIA.
A violent inflammation of the lungs occurred in
the case of Adalbert Pezimek, a merchant’s ser-
vant, young and vigorous. Without assignable
cause, he was attacked in the night of the 8th of
May with difficult breathing, great restlessness,
and an oppressive pain at the sternum ; joined to
which was a cough, with expectoration streaked
with blood. On the 11th these symptoms had
increased to a great degree, and a good deal of
blood was mixed with the expectoration. Two
copious bleedings, at which the blood was covered
with a thick inflammatory crust, and some appli-
cations of leeches produced immediate relief ; with
the use of emollient, cooling remedies, viz., Dec.
Alth. cum Pot. nit., and emollient cataplasms, he
got quite well in ten days.
ISCHIAS.
A sciatica of the right side, in which the pain
extended chiefly from the outside of the joint
down the thigh, was cured in a few days, in a
woman forty-seven years old, by cupping at the
hip joint, and in the course of the sciatic nerve,
and the use of some laxative eccoprotic remedies,
as Althaea, Gramen with Sod. sulph., or Pot. nit.
and Roob Sambuci.
c: 244 ]
PLEUROPERIPNEUMONIA CHRONICA ET HY'DRO-
THORAX.
The post mortem examination of a journey-
woman, forty-eight years old, deserves particular
notice. She was tainted with syphilis, and for
five weeks had suffered with stitches, and oppres-
sion of the breast, attended with cough and tight-
ness. Yet, according to her, these complaints
were relieved without medicine. AVhen she was
admitted, there was heaviness of the head, the
face was cold, the tongue dry, with a greenish
covering, the breathing much impeded by tight-
ness of the chest ; there was a sharp pain on the
left side under the ribs, which was increased by a
deep inspiration ; the expectoration was of a saf-
fron colour, tenacious, and in great quantity ; the
pulse very frequent, small, and depressed ; not
admitting of further depletion. Mucilaginous
cooling remedies. Calomel, Ant. sulph. prjecip,
blistei’s, leeches, and cupping were employed
without effect.
On opening the thorax, the left lung was found
hepatized, and compressed into a small bulk, and
a good deal of water on this side — there was an
uncommon quantity of it in the pericardium —
which was itself thickened ; on the surface of the
heart was a quantity of exuded lymph, that organ
was pale and flabby, evident traces of previous
inflammation. In the abdomen, the spleen was
found attached to the neighbouring parts by liga-
mentous matter, not unlike the jelly of plumbs, it
appeared sphacelous, and its coat cartilaginous.
There wei’e marks of syphilitic infection about
the pudendum, viz., condylomata and fluor albus.
C 245 :]
HEPATITIS ET ENTERITIS.
In this month we also lost a patient, twenty-one
years old, servant in a coffee-house. She had a
very cachectic look; two years ago had hae-
moptysis, then syphilis, and greatly injured her
health by an irregular course of life. In conse-
quence of some domestic trouble, she drank a
quantity of spirits, on which she fell senseless to
the ground. Fever, headache, bitter eructation
and vomiting were the principal symptoms which
induced her to seek relief in the clinical hospital.
The abdomen was painful and hard to the touch
in the epigastric region, a deep inspiration increas-
ed this pain ; her taste was bitter, she had fre-
quent eructation and vomiting; the jiulse was
fr^uent, small, and oppressed.
The disease was pronounced an inflammation
of the liver, particularly of its left lobe. The
antiphlogistic treatment, with repeated topical
bleeding, emollient cataplasms, and soothing ec-
coprotic remedies was adopted ; camphor and
mercurial friction were later employed ; but
purging and vomiting followed, and she died
on the fifth day.
On examining the body, the lungs were found
in their natural state ; yet there was a consider-
able quantity of water in the cavity of the chest.
In the pericardium about two ounces of bloody
fluid; the heart very much wrinkled. In the
cavity of the abdomen, the small intestines were
inflamed at their surface, the gall-bladder dis-
tended, the liver uncommonly large, and had
many pseudo-membranes on its convex surface,
the pylorus was very soft, the spleen indurated,
the kidneys very large, the vagina inflamed.
y 3
n 246 ;]
JUNE.
Bar.
Ther.
Highest . . .
, . . .28.737 . . . .
Lowest . . .
. . .27.835 . . . .
. . . .48.
2
Mean . . . .
. . .28.786 . . . .
1
The prevailing wind was the south-west.
The beginning of June was marked by clear,
but yet cool days ; soon after, great heat came on
suddenly. On the 13th it was quite cold, with
much rain ; the sky continued cloudy. On the
20th, snow fell in the mountains, a very uncom-
mon appearance. The rain continued ; it was
particularly strong on the 24th and 2oth, when
the rivers swelled to an amazing height, which
caused such a dreadful inundation as had not
been seen for forty years before.
Rheumatic fevers, pains in the head, erj’sipelas,
and intermittents were frequent in this month.
Bad cases of diarrhoea were almost general — an
effect of the suppressed cutaneous secretion, from
the moistui*e. They required mucilaginous reme-
dies, warm infusions, and ipecacuan in divided
doses. In the city a bad kind of scarlet fever
prevailed here and there, which, in one case,
proved fatal on the fourth day, and in another,
even on the second.
SPLENITIS.
Barbara IMuller, a maid-servant, twenty-five
years old, after a violent dispute was seized with
shivering, subsequent heat, and headache ; which
was soon followed by a darting, burning pain of
the left side, which extended itself to the left:
shoulder. A vomiting of dark-coloured blood
c: 247 3
also came on, which returned at intervals. When,
on the 20th of June, she was admitted into the
clinical hospital, the symptoms had considerably
increased ; she could not bear pressure on the
left hypochondrium, and she there felt a burning
pain, which extended to the pit of the stomach ;
the hawking and vomiting of a bloody fluid con-
tinued, the pulse was frequent, rather hard and
oppressed, her appearance cachectic.
She had Dec. Alth. mannat. ordered, eight
leeches to the region of the spleen, and emollient
cataplasms. Relief certainly followed ; still she
could not bear pressure on the part; and the
vomiting, though less frequent, still continued.
Three cupping-glasses were now applied to the
part affected, and the other remedies continued as
before. On the sixth dav, the disease terminated
•> *
with an abundant diaphoresis, and mucous sedi-
ment in the urine. Some inconsiderable tension,
and tenderness of the left side went off by the
continued application of warm cataplasms, and
taking the Decoct. Althaeas.
RHEUMATISMUS ACUTUS PEDIS.
A country young woman, nineteen years old,
by name Maria Pechiczkowa, was admitted for
violent lancinating ])ains in the calf of the leg,
which she had before in the joint of the knee,
attended with fever. She could not walk, or bear
the part to be handled ; there was a degree of
swelling perceptible. Some cupping-glasses were
applied along the calf, the leg was wrapped in
warm cloths; she took Dec. Alth. cum Pot. nit.
et Roob Sambuci. The pains were considerably
diminished as well as the fever, though they
would not entirely yield ; for which mercurial
c: 248 3
friction, and lastly, a blister in the form of a
garter, was applied below the knee; inwardly,
Dec. Gram., Potass, tart, and Roob Sambuci
were given. With this treatment she soon re-
gained her health.
EPILEPSIA.
A case of epilepsy merits notice, in which the
oxyd of zinc was, for the second time this year,
efficacious. Magdalena Sauczkin, thirty-three
years old, a maid-servant, enjoyed general good
health, but, on the 11th of June, had such a
violent fright, that she fell into strong convul-
sions ; she lost her consciousness, the face was
swollen, she foamed at the mouth, and, after a
quarter of an hour in this state, she fell into a
profound sleep, out of which when she awoke
she remembered nothing of what had occurred,
but felt herself very much fatigued and cast down.
On the same day, as well as on the 12th, she had
several similar attacks.
When she came into the clinical hospital there
was no morbid appearance observable, except
exhaustion, a flushed countenance, want of appe-
tite, and increased thirst ; the mistura temperans
(ex Pot. supert. et test, praep.) and Zinc Oxyd.
gr.j. were given every three hours. The pa-
roxysms ceased from this time, and in a fortnight
she left the hospital in perfect health.
PLEUROPERIPNEUMONIA.
A maid-servant, twenty-two years old, came on
the fourth day of her illness, with heat, flushed
countenance, thirst, darting and oppressive pain,
which was increased by a deep inspiration, cough,
and viscid expectoration ; the pulse hard and full.
C 249 ]
A copious bleeding, and afterwards six leeches
to the chest ; inwardly, Dec. antiphlogist. and
the application of emollient cataplasms restored
the patient in ten days.
REMARKS ON SYPHILIS.
The forms under which syphilis appeared in
this year were various; in the clinical hospital
they were united mostly with other diseases, es-
pecially febrile ones of every kind, and which
last were most considered in forming the diagno-
sis. The chief symptoms were eruptions of the
skin, sore throat, or ulcers in the nose or geni-
tals, fluor albus, condylomatose excrescences in
various parts of the body, nocturnal pains in the
bones, and nodes. With regard to the treatment,
the febrile affection afforded generally the chief
indication ; and it was not till this was removed,
that the syphilitic affection could be particularly
attended to. In general, the chief remedy op-
posed to this disease was mercury, and we endea-
voured to bring it into use as soon as circum-
stances, and the accompanying morbid symptoms
admitted of it ; and here the maxim of preferring
its milder preparations, when they were sufficient
for the cure, was observed.
Salivation was not excited or kept up as neces-
sary to the cure, it rather gave the hint, worthy
of our attention, that the constitution was satu-
rated with the specific, and that a truce should
be put to its further employment. Hence, as soon
as signs of salivation appeared, such as swelling
of the gums, bad smell from the breath, heat and
pain in the mouth, increased secretion of saliva,
or the peculiar sensation of the teeth being longer
or softer than usual, the mercury was suspended,
i; 230 :
and the mouth kept clean by rinsing it with luke-
warm emollient infusions. The full development
of the salivation was generally prevented by these
means, but in other cases, where the patient had
taken before his admission a great quantity of
mercury, and where, notwithstanding its discon-
tinuance, salivation came on to a great degree,
the case was considered as one of great irritation,
and treated with emollient lotions for the mouth,
and with derivative remedies, more especially such
as acted by the bowels and skin, and thus it was
without difficulty removed. There was no case
where, even from the most violent salivation, any'
serious consequence followed ; not even the loss
of the teeth.
Syphilitic eruptions vvere usually troublesome ;
for their cure Calomel, or Mercur. solub. nig. *
were generally employed, and the cure was more-
over furthered by the decoctions of R. Bardanse,
Dulcamara, Sarsaparilla, or Guaiacum. So also
were syphilitic sores, w’hether primary or secondary,
always treated with mercury, and generally in its
mildest form ; but the local treatment was always
considered as essential to their cure. And here
it is necessary to observe in what state the sore
may be, viz., whether irritation and inflammation
are present, which are clearly shewn by more or
less of pain, redness, dryness, sw'elling and ten-
sion ; or whether it is in a state of insensibility
and torpor. In the former, and much more com-
mon case, tepid emollient fomentations and lo-
tions, and even covering it with a mild salve, are
very useful, and hasten the cure ; but in the se-
• Obtained by precipitating with .ammonia, merenn’ dissolved
in nitric acid.
[ 251 ;]
cond case, it is necessary to call forth more life
and activity in the surface of the sores, by stimu-
lant remedies, in which mei’curial preparations
have the best effect ; hence touching the part
with Argenti nitras, or sprinkling it with red pre-
cipitate and sugai’, as a vehicle, and, according to
circumstances, with camphor added to it.
In both cases the greatest attention to cleanli-
ness forwards this object, as the frequent ablution
with tepid water, the introducing of clean dossils
of lint between the surfaces of the ulcers, espe-
cially in the genitals, and keeping the sound parts
free from the ichorous discharge.
Condylomatous excrescences, when solitary and
with narrow bases, were removed at different times
with the scissors, and when they sprung up again,
they were touched with caustic. When from the
broad basis, or their great number, they could not
be removed, they were treated with caustics, such
as Argenti nitras, or Butyrum antimonii, but mer-
cui’y was always given internally. In condylomata
of the prepuce, %vhich so readily grew again,
bathing the part in a rather strong solution of
corrosive sublimate had the best effect.
In obstinate forms of syphilis,'especially in pains
of the bones and nodes, a more powerful prepara-
tion of mercury, viz., Hydrarg. oxymui’. was em-
ployed. It was given partly in solution, (a grain
to five or six ounces of distilled water, of which
a table-spoonful was taken night and morning)
partly in pills, when the above-named decoctions
and aljundant mucilaginous remedies were at the
same time administered.
A few detached cases may serve more effectu-
ally to throw light on the minutiae of the treat-
ment.
c 252 ;]
CONDYLOMATA FACIEI.
A woman, thirty-four years old, came, on the
7th of April, 1824, w'ith symptoms of general sy-
philis, into the public hospital. On several parts
of the face, as the upper lip, the side of the nose,
the chin, the forehead, and in the neck, there
were found condylomatous spots, an inch broad,
round, and raised some lines above the skin, con-
taining, under a brown crust, an ichorous matter,
the scalp had likewise similar crusts and sores,
only with this difference, that they were not raised
above the skin. On the rest of the body there
was no farther trace of the disease, though she
was conscious of having had it from an impure
connexion.
According to her account, she had observed
these appearances for more than eight weeks, her
health otherwise not impaired ; in the beginning,
scaly eruptions came out here and there on the
face, which daily increased in extent, and raised
themselves above the skin. She had ordered,
Mercur. solub. nig. gr. ij., in Sacch. pur. ^j. m. f.
Pulv. div. in dos. N® sex., one to be taken night
and morning. Dec. Bardanse pro potu., and for
touching the condylomatose ulcerated excrescen-
ces of the skin, Hyd. oxym. gr. ij. solv. in .-\q.
distill, jiv. But the signs of ptyalism soon ap-
peared, the breath became fetid, the gums easily
bled, and the teeth had the peculiar blunted feel.
The mercury was suspended and tepid gargles
of Dec. Althasee were ordered ; inwardly. Soda?
sulph. dissolved in water, so as to procure some
stools. The symptoms soon gave way, and the
mercury was resumed.
As she was so readily salivated, and as her
C 253 n
complaints had from time become rooted and ex-
tended over- the system, the following was given :
Aq.dist.5iv; Aq. Cort. Aur. 5j ; Hyd. Oxym.
gr. j ; Tinct. opii gutt. xx. a table-spoonful (made of
wood) to be taken night and morning. Even with
this remedy for some time used, the ptyalism
threatened a retmm ; but its complete develop-
ment was prevented by the derivative method,
especially by neutral salts, emollient lotions for the
mouth, and some small doses of Sulphur sublim.
When this was effected, she went on again with
the above remedy, till every morbid symptom had
disappeared. With this periodical use of the sub-
limate, and its topical application, the condylomata
decreased, and in six weeks entirely disappeared.
The hairy scalp was the first part to get well: she
was discharged cured on the 2d of July.
The venereal disease appeared in another form,
viz., with ulcers and fluor albus, in a maid-servant,
seventeen years of age ; she had chancres on the
genitals, which covered their inner and outer sur-
face, and presented a frightful appearance, causing
wounds and great pain from contact of the urine;
she had, moreover, an inflammatory rheumatic
fever, with a stiff neck, and difficulty in swallow-
ing ; emollient cataplasms were applied to the
neck, and she took Dec. Alth. cum Pot. nit. et
Roob Sambuci, to which, on account of costive-
ness, Sod. sulph. 5ss. was added ; as to the local
complaints, the ulcers as well as the excoriated
parts were occasionally washed with tepid water,
and clean dossils of lint introduced between them.
After the violence of the fever was abated, the
mercurial remedies were administered, viz., half a
grain of calomel night and morning, and she went
on with this alone after the diminished febrile
7.
c: 254 3
symptoms required no further remedies ; she took
the calomel in the above dose for about a month,
notwithstanding which no signs of ptyalism ap-
peared, and in that time the ulcers as well as the
fluor albus were entirely cured.
This disease made its appearance in the form
of condylomata about the anus, in a girl of the
to\m, twenty-seven years of age ; these were more
or less elevated, red, cauliflower-like excrescences,
which gave no inconvenience except a little itch-
ing; as these were thin at the base, they were
partly removed by scissors inclined according to
the surface, and the bleeding stopped with a com-
press of lint : she took powders containing half a
grain of calomel twice a day; and thus, by de-
grees, were the whole of these warts removed by
excision. When from the breadth of the base
this could not be adopted, they were touched with
Butyrum Antimonii once daily, by means of a
pencil; or sometimes burnt with caustic, especially
when after removal with the scissors they threat-
ened a return, or could not otherwise be eradi-
cated from the base. It required seven weeks
entirely to destroy this adventitious organization,
and to complete the cure.
ERYSIPELAS FACIEI.
Erysipelatous inflammations occur pretty fre-
quently in these parts ; females are most subject
to them, especially maid-servants, who are so often
exposed to the exciting causes. Though this dis-
ease is not of itself always attended with danger, it
is still important, and readily passes, especially when
mismanaged, to some vital organ, when it becomes
dangerous and often flital. A melancholy example
of this occurred this year, shewing that our art is
C 255 3
often incapable of remedying the mischief occa-
sioned by ignorant interference.
Anna Czerney, thirty years old, of a pretty
strong habit of body, had enjoyed good health,
and except some complaints when she began to
menstruate, was a stranger to any disease. On
the 10th of June, this year, she had a violent
fright, was afterwards seized with shivering and
heat, and became thirsty. After twenty-four
hours she felt a burning itching in the face, and a
painful tension, with which this part became
swollen, and of a shining red colour ; as these
symptoms increased, she was soon obliged to keep
her bed, during which time the erysipelas spread
over the hairy scalp, on to the neck. Several re-
medies were used, among which some, as white
lead, were very improper, and greatly increased
the mischief. The eyes were swollen and closed,
blisters formed on the face, which contained a
serous ichor, and passed into scabs which covered
the face like a mask, and gave her a monstrous
appearance ; when on the 18th of June, the eighth
day of her illness, she came into the clinical
hospital, the erysipelatous inflammation extended
over the whole head to the neck, and even deep
into the meatus auditorius. She did not complain
of any headache, but the tongue was dry, covered
with a brown crust, the thirst very great, occa-
sionally a dry cough unattended with pain, her
breathing free, the abdomen free from pain and
soft, the urine of a deep red colour without sedi-
ment, the stools as yet always costive, the heat of
the skin much increased, the pulse moderately
frequent and soft. Decoct. Gram, cum Pot. tart,
et Roob Sambuci were ordered, and the head and
face covered with thoroughly dry warmed cloths.
c: 256 n
The following days (19th and 20th of June)
there was an appearance of improvement, the
bowels were gently opened, the swelling of the
face was less, the scabs fell off, and there was a
separation of the cuticle on the face; the mental
functions were not impeded, the fever continued
moderate, but the tongue was always dry and
coated, the heat of the skin greatly increased, and
the urine of a dark red colour. Whilst the erysi-
pelas left the face, it extended itself over the back,
shoulders and breast, and one might daily discern
what progress it had made. On the 21st of June,
she had several loose stools, for which Dec. Salep.
spiss. with a few grains of Ammon, inuriat. was
given, and powders, with one-third of a grain of
ipecacuan, were directed to be taken every three
hours, by which they were soon repressed. Whilst
the erysipelas was extending itself over the body
and upper extremities, the 23d of June (the thir-
teenth day of the disease) had arrived without any
critical appearance in the urine or by sweat ; the
disease had now already extended to the elbows,
also over the back, breast and belly, to the half
of the thigh, and there it suddenly stopped short.
In the night between the 23d and 24-th of June,
she had sometimes wandered, but at the morning
visit she was perfectly composed, gave rational
answers, and had nothing to complain of except
that her cough was somewhat more troublesome.
The ])idse was sufficiently strong, moderately fre-
cjuent, the fever on the whole was not too violent ;
the black tongue and want of all critical signs alone
made the prognosis unfavourable. Dec. Alth. *
* Here, as in all cases where the quantity of the rcliicle is
not mentioned, half a pint is understood ; the dose of the other
ingredients may be inferred from cases where they are specified.
: 237 3
cum Ammon, muriat. et Ext. Hyosc. was given,
and a blister applied to the neck.
Now however, new unfavourable symptoms came
on daily, the wandering was more constant, and
she lost her consciousness entirely, she fell into
a comatose state, and on the 27th of June the ery-
sipelas suddenly disappeared, and the pidse could
not be counted ; repeated blisters and sinapisms,
and camphor inwardly, were inefficacious, and she
died towards evening.
Examination of the body. — On opening the
cranium, nothing extraordinary appeareil besides
some turgescence of the vessels of the brain and
its coats. The chest and abdomen were found in
a natural state. Considerable putrefaction had in
twenty-four hours taken place. In this case the
examination did not afford any instruction.
JULY.
Bar.
Ther.
Highest . . .
, . . .28.79
88.25
Lowest . . . .
. . .28.292
Mean
,...28.541
72.05
The prevalent winds were the north-west and
south- west.
The month of July was remarkable by its un-
settled weather, at one time warm and clear, then
suddenly changing for storms with violent rain and
alternate hail. The inundations were at the be-
ginning of the month still pretty high, and perni-
cious vapours exhaled from the streets and cellars.
and the directions in the note at pa«e 29, of course .apply ; on
which last it may be remarked, that the lialf pint mixture serves
for the twenty-four hours, the German spoon being somewhat
less than Jss. and some part of that period being allowed for
sleep.
z 3
c: 258 :]
The prevalent character of the fevers was the
gastric and nervous, the latter somewhat violent,
especially when the cases were attended with much
diarrhoea : it made its appearance with great hea-
viness of the head, and often inflammatory irrita-
tion of the brain, with delirium, and also with me-
teorismus.
Erysipelatous inflammations were frequent, as
well of the head as of the other parts, which were
generally dangerous, and much disposed to me-
tastasis inwards. HEemorrhagies of the womb
were more common than usual, caused partly by
miscarriages, partly by debility, they required, in
general, a tonic stimulant practice. Aqua et Tinct.
Cinnamom, Cinchona, Alumen, Kino, and Ipeca-
cuanha, in divided doses, were the remedies used.
The cases most worthy of notice in this month
were the following: —
HYDROPS UNIVERSALIS.
An old woman, in her eightieth year,, living in
want and misery in a damp cold dwelling, became
dropsical ; her feet oedematous and the abdomen
greatly distended, her breathing difficult, so that
she was unable' to lie in the horizontal posture.
She had been in this state six weeks, when she
came under our care. A solution of Potass, sub-
carb. in Acet. Scillae with Inf Herb. Petroselin,
and as a diarrhoea came on, Infus. Rad. Levistici.
cum Ext. Scillm, with inunction of Ung. Digitalis
Ol. Junip. et Terebinth, on the belly, and lastly
Infus. Levistici cum Sp. /Eth. nit., brought on a
copious diuresis, and restored her in a short time.
PHRENITIS LACTEA LEVIOR.
A country woman, twenty-years old, had suckled
[ 259 ]
her child during a month ; but as this was incon-
venient to her on account of her service, she
weaned it, and endeavoured to repel the milk by
the application of lard. The breast, however,
swelled much, became painful, hard and inflamed.
On the 4th day, she was taken with violent head-
ache, shivering and heat ; she passed restless
nights with turbulent frightful dreams, slight wan-
dering and loss of consciousnes, her thirst was
increased, the bowels costive. When she was
admitted (the fourth day of her illness) the fever
was moderate. Ordered, Dec. Gram, cum Potass,
tart. 5vj ; powders with half a grain of calomel,
emollient fomentations and vapour to the breasts,
glysters, and drawing off* the milk as soon as the
breasts admitted of it. Soon after the emollient
vapours were applied, the tension of the breasts
gave way, they became softer, and the milk could
be drawn off by the gentle application of the
glasses for that purpose, it even flowed spontane-
ously. Several loose stools which followed effected
an immediate general amendment, especially of
the head, which became proportionably relieved as
the evacuations by the bowels and the breasts
proceeded without interruption. The ui’ine threw
down a copious sediment. A milk schirrus, how-
ever, in the right breast threatened, notwithstand-
ing this treatment, to become troublesome ; the
swelling was more prominent in this part, was
pointed and very painful. Emollient cataplasms
were diligently applied, and mercurial friction was
directed to be used around it : the inflammation
and swelling diminished, the schirrus began to
disperse, which was encouraged by cataplasms
with Species emollient., et Herb. Conii., and during
the night with emplast. Conii ; these had the de-
c: 260 :i
sired effect of entirely dispersing the schirrus,
and she left the hospital quite well.
Another case of this kind occurred in the month
of August in a maid-servant, who, on the 26th of
July, had been safely delivered in the lying-in
hospital, and had perfectly recovered. On the
27th the breasts filled with milk with the usual
symptoms, and a slight shivering, and she under-
took the office of a wet nurse. On the 31st she
went to bed quite well, and had a good night’s rest ;
but in the morning her behaviour became of a
sudden strange, her countenance was distorted,
she cried out and sung with extraordinary gesticu-
lations. The limbs felt cold, the face pale, whilst
the head was hot, and the pulse frequent, strong
and full. The breasts were flaccid, and without
milk. Leeches were applied to the temples, cold
poultices to the head, and warm cloths to the
breasts ; glysters and dry cupping ordered, and
stimulants of horse-radish and vinegar applied to
the calves of the legs ; and she was speedily
brought into the general hospital, where she was
admitted on the 1st of August in the following
state : — Her consciousness had returned, she gave
rational answers to ^juestions made her, and com-
plained of a dull headache ; there was something
however confused in her look, the head was mode-
rately warm, the breasts already full of milk, tense,
hard and sensible to the touch, the belly distended
without pain, she had had stools, the urine was of
a dark yellow colour with a mucous sediment, the
heat of the skin moderate, the pulse rapid, full and
soft. Ordered, Decoct. Gram, cum Potass, sulph.
5ss ; and powders, with a grain of calomel every
two hours, and emollient fomentations to be ap-
plied to the breasts. She had soon copious eva-
[ 261 ;]
cuations from the bowels, the abdomen subsided,
the head was relieved, and on the following day,
(2d of August) she was very much better, and
her appetite returned. The milk flowed sponta-
neouly from the breasts with the fomentation, the
tension diminished, they became soft and without
pain, there was a copious white sediment in the
urine, the skin was moist, the fever moderate.
The powders were reduced to half a grain
twice a day, and the Pot. sulph. to two drachms
in the mixture ; a strict diet was enjoined. The
milk continued to empty itself for some days, and
became less in proportion to the increased excre-
tion from the bowels. The breasts were now
merely covered with dry warm cloths, the powders
w’ere laid aside, the mixture continued in such
manner as to procure two or three evacuations
daily. On the 14th, she was discharged cured.
OTITIS.
A young woman, twenty years old, got, as the
consequence of exposure to cold, an inflammation
of the ear, attended with fever, violent darting
pain, and tumefaction of the meatus externus, loss
of hearin" on the right side, and at the same time
violent pain in the left ear. When she spoke or
swallowed the pain was increased, both tonsils
were swollen and inflamed, the pulse rather hard
and oppressed ; it was the eighth day of the dis-
ease ; six leeches were applied to the neck, and
on the following day four more to the right ear;
emollient vapours and cataplasms; inwardly, cool-
ing antiphlogistic remedies. Afterwards, when the
fever was less and the pain continued, a blister was
ordered to the back of the neck and mercurial
friction. The inflammation was fortunately dis-
i: 262 ]
persed, but a violent sciatic pain now came on
in the left limb, which again rendered necessary
the repeated application of cupping-glasses with
scarification, in the course of the sciatic nerve. In
three weeks time she was discharged cured.
H.EMATEMESIS.
A weakly cachectic looking young woman fell
into a violent passion, and afterwards drank some
glasses of punch. She soon found herself indis-
posed, with a sense of heat in the region of the
stomach, and nausea, and she vomited some black
fluid blood. When on the second day she came
into the hospital, these symptoms continued, there
was no fever, the pulse was small, contracted, the
region of the spleen and stomach very tender.
The vomiting of blood as well as the other mor-
bid symptoms ceased with the application of some
leeches to the left hypochondrium, and the use of
cooling subacid remedies, as Dec. Gram. Tama-
rindinat. cum Potass, tart.; in ten days she left the
hospital cured.
ARTHRITIS VAGA.
A dangerous case of this disease occurred in a
maid-servant, in her forty-first year ; she had not
before had the disease ; the wrists and finger
joints, as well as those of the metatarsus were
seized with inflammatory swelling, all motion pre-
vented, and painful. A pretty strong inflamma-
tory fever came on, it was treated with antiphlo-
gistic remedies, as Dec. Gram, cum Pot. nit. Pot.
sulph. et Roob Sambuci; and Dec. Hord. cum
Acid. Tartar, pi’o potu, with dry warm covering
of tow. But these symptoms disappeared unex-
pectedly in the above joints, and an affection of
c: 263 n
the chest came on with unequal pulse, anxiety,
and burning pain in the region of the heart.
Blisters applied to the calves of the legs drew
the arthritic aftection to the knee-joints, and the
chest was relieved ; she stated that she was very
subject to constipation of the bowels, Dec. Gram,
cum Mag. sulph. et Roob Sambuci was given ;
but the pain and swelling now quitted the knees
and attacked the head, which became evident,
from the pain and heaviness of that part. Ram-
bling and tinnitus came on, the countenance was
pale, fallen in, and peculiarly disfigured. (Metas-
tasis ad meninges) derivative remedies, blisters
and calomel averted the danger ; the disease ap-
peared again in both wrists, and afterwards in the
foot, the head became free, and now, on the twenty-
first day of the disease, the urine for the first time
deposited a mucous sediment, and the skin, till
now dry, broke out in perspiration ; to further
which diaphoretic remedies were given, as Dec.
Gram. cum. Ant. Diaph. non ablut. ; Liq. Am-
mon. acetat. Stipit. Dulcamar ; and lastly, Plum-
mer’s powder and aconite.
She became almost convalescent, when an oede-
matous swelling came on the ankle, but it was dis-
persed by Spirit. Camphorat. and dry warmth.
She left the hospital quite well in a month’s time.
METR0RRHAC4IA.
A stout maid-servant, eighteen years old, two
months gone with child, raised a heavy cask of
water from the ground, and felt a trifling pain in
the womb, soon after which blood came away, and
in a few hours it increased so that lumps of clotted
blood were thrown out. A surgeon directed some
medicine and cold applications, with which the
c: 264 ;]
haemorrhage was somewhat stilled, but yet it went
on during four days, when she sought relief at the
clinical hospital. She was feverish, complained
of pain over the symphysis pubis, which, however,
bore pressure. Decoct. Gramin. Tamarindinat.
cum Potass, supertart, et Syrup. Rubi, was order-
ed, with absolute quiet ; in six days all the symp-
toms were removed, and she left the hospital
cured.
CONVULSIONES.
One of the students in surgery, in narrow cir-
cumstances, lost his money, and fell, from alarm,
into the most violent convulsions, with loss of con-
sciousness. Violent gnashing of the teeth, biting
of the tongue, and locked jaw (trismus) with occa-
sional curvature of the body backwards, spasmo-
dic clenching of the fists with the thumbs included,
uttering a deep roar, violent palpitation of the
heart, and irregular intermitting pulse. He was
bled to eight ounces, sinapisms were applied to
the pit of the stomach and breast, glysters of Inf.
Anthem, were given ; inwardly, the !Mist. tem-
perans cum Aquse, Lauro-ceras. 5ss. and Zinci
Oxyd. w'ere given, and in two days he recovered.
AUGUST.
Bar.
Ther.
Highest. . . .
... 28.776....
....83.75
Lowest . . . .
. .. 28.2d5
.%Q OQ
jMean
... 28.515....
....71.48
The prevalent wind was the south-east.
In August the heat was considerable on some
days, at the same time the nights and mornings
were sensibly cold. Fe\v days were without rain,
so that on the whole this month was rather re-
c: 265 :]
markable for its moisture. It was only in the last
three days of it that fine summer weather set in.
The prevalent character of the diseases was the
rheumatic and mild inflammatory, as well as bili-
ous ; many rheumatic pleurisies appeared, and
also putrid fevers. In other respects the fewest
cases occurred in this month, yet several haemor-
rhages of the womb, consumptions, and dropsies
were brought into the general hospital. In gene-
ral, therefore, in this year, arthritis, rheumatic
and nervous fevers, inflammations of the chest and
diarrhoeas, were the most prevalent diseases. Fe-
vers of a nervous character especially were unusu-
ally frequent, but for the most part of a mild sort,
with which the experience of Dr. Held, at that
time Dean of the Faculty of Medicine, and Phy-
sician to the Barmherzigen Hospital, coincides.
Sore throats, croup, and haemoptysis, puerperal
fever, and other inflammatory affections of the ab-
domen, were less frequent than usual ; but inter-
mittent fevers were more so.
The small-pox, measles, and scarlet fever were
rare, and the contagious typhus scarcely seen.
HYDROTHORAX ACUTUS.
A stout young girl, in the ninth month of her
pregnancy, was seized with oppression at the
breast, with cough and difficult respiration. She
took no care of herself, and in a week her
feet, arms and face began to swell with oedema.
She could only lie with the chest raised, and ra-
ther in a sitting posture ; the breath was short
and oppressed. She was delivered in this state of
a healthy child, and came the second day after its
birth (the 1st of August) under our care. The
face, hands and feet were dropsical, and pressure
2 A
C 266 ;]
on them left a deep mark, the skin was hotter
than natural, the oppression in breathing had in-
ci’eased, the respiration was extremely difficult,
and when she breathed deep it excited coughing ;
the abdomen was swollen, soft, but painful on
pressure, the lochia flowed properly, the urine and
stools were deficient, the pulse frequent, rather
hard, and oppressed. Six leeches were applied
to the sternum, and Dec. Alth. cum Pot. nit.. Pot-
ass. sulph. et Oxymell. simp, given. The follow-
ing night was very restless and wnthout sleep,
darting pains had come on at the left side of the
thorax, which were increased on a deep inspira-
tion ; the fever continued the same ; six more
leeches were applied to the part where the pain
was felt. Powders with half a grain of calomel,
and one-third of a grain of digitalis, were given
three times a day, and emollient poultices and Ex-
hausting glasses were applied to the breasts which
had become painful. Her state was hence much
improved ; on the day following, the complaints of
the chest had greatly diminished, the darting pain
had almost entirely disappeared, but the oppres-
sion with some little cough still remained. The
swelling of the face, hands and feet had fallen in
an extraordinary manner, and a desirable mois-
ture was on the skin. A blister was ordered to
the sternum, which relieved the heavy and op-
presive pain there ; several loose stools and an
abundant secretion of urine took place ; hence the
Potass, sulph. was left out of the mixture, and the
powders were only given twice a day. With the
continued use of these remedies for some days,
she got quite well, and left the hospital on the
i~th of August.
C 267 3
FEBRIS NERVOSA PUTRIDA.
The following case shews the great importance
of the most particular attention to the state of the
abdominal viscera, particularly of the intestines,
in nervous and putrid fevers : —
A boy, twelve years old, fell sick on the 16th of
August, with alternate heat and rigors after un-
usual lassitude. A physician thought a gastric
fever was forming, and ordei’ed a vomit, and then
some purgative remedies, which produced an
abundant diarrhoea ; his state so far from improv-
ing, became daily worse, so much so, that on the
fifth day of his illness, (the 21st of August) when
he came into the hospital, he had all the symp-
toms of a putrid nervous fever. Great heaviness
in the head, with stupor and deafness, the counte-
nance pale and sunk, the tongue quite dry, and
covered w’ith a brownish-black coat, and cracked,
the teeth covered with a tenacious black paste,
consciousness obscured, delirium, difficult breath-
ing, the abdomen contracted, only sensible to hard
pressure, at which he awoke out of his stupor and
contracted the muscles of the face ; frequent
stools, the pulse small and very frequent. The
putrid character of the fever became more mani-
fest in its course, and ended fatally on the 28th of
August.
The remedies employed as the symptoms re-
quired, consisted in two applications of leeches
to the abdomen, blisters and sinapisms, mucilagi-
nous soothing mixtures, to which, in the course of
the disease, camphor and Had. Arnicae were add-
ed ; and when towards the end there was subsul-
tus tendinum, castor and musk were given.
On examination of the body, the head presented
C 268 :
nothing extraordinary, except some exuded lymph
between the dura mater and tunica arachnoidea ;
nor was any thing to be observed in the chest.
Even the abdomen at first sight seemed also free
from disease ; for on turning back the parietes,
the peritoneum, omentum, and intestines were
found in their natural state, and of their usual
colour ; but on exposing the intestinal canal many
red spots of from half an inch to an inch in cir-
cumference were observed, the ileum was in two
places, and for more than a foot in length of a
dark red in its whole circumference, in other
places it was contracted ; these parts when cht
open exposed the mucous membrane red as blood,
and in the highest state of inflammation ; the me-
sentery was also inflamed and its glands enlai^d
to the size of nuts.
The disease was therefore a putrid fever, the
consequence of a concealed inflammation of the
intestinal canal, the danger of which was proved
by its unfavourable termination 5 one might, in-
deed, from the symptoms conclude that there was
some inflammatory afiection, but scarcely should
one have expected such a degree of intestinal in-
flammation.
COLICA H^MORRHOIDALIS.
A tailor, of weakly habit of body, thirty-six
years old, had been for some years subject to h?e-
morrhoidal complaints, costiveness, bad digestion,
&c. In his thirty-fifth year he had die jaundice,
which required some months for its cure.
At the beginning of August, 18i24-, he was seized
with pains about the hips and loins, and could not
raise himself up ; towards the middle of the month
tliese complaints, which came on in paroxysms, in-
c: 269 ;]
creased to such a degree, that during the paroxysm
he would crawl on the ground, writhing with the
pain. The pains now extended forwards from the
loins over the abdomen ; the hypochondria were
very tender, the pulse contracted and rather hard ;
eight cupping-glasses were applied^ to the loins;
Decoct. Gram, cum Pulp. Prunor. et Pot. tart. ;
glysters and cataplasms were ordered. Some relief
followed, but of short duration, as the paroxysms
returned again, and brought him into the most
painful condition ; nor did the renewed applica-
tion of leeches to the loins procure any permanent
alleviation. Powders with three grains of Sulph.
sublim. were given three times a day, and their
effect was quick and striking ; for in twelve hours
the pains had vanished, nor did they again return.
After a few days, which he remained for observa-
tion, he left the hospital cured.
COLICA INFLAMMATORIA CUM ILEO.
The following was a case of the greatest danger.
— Anna Smolikin, thirty years of age, a maid-
servant, of weakly habit of body, fell sick, as she
related, on the 18th of August, from eating unripe
fruit ; she was taken with violent pains in the ab-
domen, which returned at intervals. A woman
gave her some sort of purging medicine, as she was
very costive, but no evacuation took place, and she
became soon worse; the abdomen became distended,
and attacks of agonizing pain almost took away
her senses. In this state she came, on the 23d of
August, under our care : she had not much fever,
the heat of the skin was mild, she bore slight
pressure on the abdomen, and only felt pain when
it was considerable. Mistura oleosa, glysters, eight
leeches, and emollient cataplasms were ordered.
2a3
i; 270 3
On the 24th, eructations and frequent retching
came on, and she had had no stool ; six more
leeches were applied to the abdomen, and powders
with half a grain of calomel, with the emulsio
gummosa, given every two hours; she went on
with the glysters and emollient fomentations.
On the 25th, she had vomited occasionally dur-
ing the night, her state was somewhat easier, the
distension of the abdomen the same, a very slight
evacuation had taken place ; the dose of calomel
was increased to a grain, and eight more leeches
■were applied to the belly. On the 26th, she had
again occasionally vomited, and brought up a stink-
ing yellow fluid, which resembled liquid feces, two
lumbrici’were brought up at the same time. The
fever continued moderate, and on firm pressure
she still felt pain deep in the abdomen ; she had
had two scanty stools, and some fecal matter had
been discharged ; eight cupping-glasses were now'
applied to the abdomen, the dose of calomel aug-
mented to two grains every three hours, the mix-
ture w'as continued, and a table spoonful of Ol.
Ricini given every two hours.
On the 27th, the state of the patient was the
same ; she had had no stool, and had not vomited ;
ordered, Ol. Ricini, Mucil. Acac. Syr. Alth. ai ^ss.
Aq. dist. 5vj; Magn. sulph. 5''j* 28th,
she had again vomited fecal matter, and another
worm came away ; satisfactory evacuations now
took place. On the 29th she had tw'o stools, but
still had brought up the same matter ; the belly
now bore strong pressure, and she only felt a
trifling pain deeply seated, but it still remained
very much swollen and tense, the pulse natural
and fi'ee from fever. In order to affect the intes-
tinal evacuation, she had ordered Mist. Oleos. ®iv.
C 271 3
Inf. Sennas comp, On the 30th she was much
the same ; stercoraceous vomiting had twice oc-
curred, and one evacuation downwards ; she had
now Dec. Alth. cum INIannee 3j> and a tepid bath.
On the 31st, Magnes. sulph. 5j- was added to the
above mixture ; she occasionally vomited, but had
two stools. On the 1st of September she took an
effervescing draught of Magnes. carb. 3ss. Acid,
tartar, gr. vj. every three hours, and the obstinate
stercoraceous vomiting ceased, not to return again ;
the patient had twelve loose evacuations, the tense
swollen belly subsided, and her appetite and health
were soon restored. On the 8th of September she
left the hospital quite well.
This disease, which was at first a colic, passed
into a slow obscure enteritis ; and it was only by
adhering to this sure indication, and persevering
in a well-directed antiphlogistic treatment, that a
favourable termination was effected. It is of prac-
tical use to note the circumstance that the vomit-
ing was only to be allayed by the effervescing
draught, a proof that after the inflammation was
subdued, a remaining sensibility of the intestines
kept up the vomiting, and could only be removed
by the carbonic acid, which here acted as a spe-
cific.
APOPLEXIA EX HEMIPLEGIA.
The following case of apoplexy shews the
marked influence which the passions have on man’s
health, and how powerfully depressing affections
of the mind more especially can undermine it, and
even in a less time than could be expected bring
about the destruction of its organization: —
Elizabeth Sankup, a maid-servant, nineteen
years old, of a stout healthy but not apoplectic
C 272 :
habit of body, was thrown into deep affliction by
a bad account she had received of her mother,
her only remaining parent, by which she lost her
appetite, quiet, and sleep. On the 18th of Janu-
ary she w'ent to bed in apparent health, but her
sister, Avho slept in the same room, observed that
she ruckled, and every attempt to awake her was
in vain. An experienced physician, who was soon
called, saw at once that it was a complete case of
apoplexy. The most appropriate remedies were
employed without delay : she was thrice bled, and
the antiphlogistic derivative method, together with
stimulants to the skin, was employed in its full
extent, by which she in some degree recovered
her consciousness ; but complete loss of speech
and paralysis of the right side remained. In this
state she was brought, on the 21st of Januarj’, the
third day of her illness, into the clinical hospital :
she manifested no pain, the mouth was distorted,
drawn towards the left side, the motion of the
tongue difficult, nor could she utter a syllable ;
the right arm hung down heavy as lead, without
any power of motion, and the sense of feeling in
it very much diminished ; the fingers were con-
tracted (the consequence of paralysis of the exten-
sors), the lower extremity of the same side was
also motionless, and the patient unable to stand or
move. As another circumstance worth notice, it
appeared that in the left and sound arm no pulse
could be felt, even with the greatest attention,
whilst in the paralytic arm it was to be felt as
usual; and was found frequent, soft and weak.
However necessary at first the antiphlogistic
treatment in a young subject from the country
might be for the preservation of life, her present
state required remedies to raise the suppressed
C 273 :i
vitality, and restore the energy of the nerves, the
most essential organs of life. With this view she
took Inf. Flor, Arnicae cum Liq. Ammon, subc. et
Ext. Arnicas ; externally, frictions with Spirit,
saponat. et camphorat. cum Tinct. Canthar. on
the lame side ; Ung. Ant. tart., to the spine, and
blisters behind the ears, and as these healed, to
both sides of the neck ; fresh mezereum bark was
applied to the arm, constipation prevented by a
few grains of jalap with calomel, and she was
directed to chew Rad. Pyrethri, several times in
the day. AVith the persevering use of these re-
medies, to which were afterwards alternately added
Senega. Spir. Ammon. Anisat. Antim. sulph.
praecip., and at the same time the daily application
of vapour to the parts, some hope of an amend-
ment took place ; she recovered her feeling in
the paralysed limbs, and the sense of heaviness in
them disappeared. Aromatic and alkaline baths
with Potassa fusa, were now employed, and these
had the most desirable eSect of restoring motion
to the lower extremity, though the arm remained
paralytic. The voice too unexpectedly returned
on the 12th of February ; but all was now effected;
for in spite of the diligent and continued use of
the remedies, to which camphor was also added,
the paralysis still remained. A change of some
consequence in the general health of the patient
took place in the fifth week ; without any assign-
able cause her strength diminished, the pulse sunk
so as to be threadlike, ulceration took place on
the sacrum, she became daily weaker, and com-
plete exhaustion of the vital functions threatened
a speedy unfavourable issue. The stimulating
method was now adapted to its greatest extent,
to support life, which seemed every moment on
: 274 ]
the point of extinction. Cinchona, with increased
doses of camphor, Valerian, R. Angelicae, with
iEthereal spirits, and the Tinct. nervino-tonica
Bestucheffii (see page 193), spirituous frictions and
lotions, blisters, strengthening exciting food, and
particularly wine, recalled life into the paralyzed
organs, and by degrees she was restored in six
weeks time ; and as her strength returned, the
power of moving the paralytic leg increased, the
pulse was now again perceptible in the left arm,
but did not acquire the strength and development
of that in the right or paralytic arm, and it re-
mained always indistinct.
To produce by our art still some effect on the
paralysis, the galvanic pile was now employed ; at
f;rst, ten pair of plates were used, and the patient
subjected to the electric current by placing one
pile to the shoulder, and the other to the back of
the foot of the paralyzed side, and continuing the
operation from a quarter to half an hour. After
some days the piles were changed, and that which
was lowest placed uppermost. So also the plates
were increased to twenty, and lastly to thirty pairs,
without her experiencing any remarkably unplea-
sant sensation ; but there came little sores of a
particular form in the places to which the chains
were applied, which discharged a serous fluid, and
left black marks behind ; the beneficial effect of
this excellent and too much neglected remedy
soon began to appear, the voice returned with
more force, and she was able to speak ; and how-
ever imperfect, stammering, and unintelligible her
speech was at first, (for she could only with great
effort repeat words which were spoken to her) it
soon became more developed. The distorted
mouth recovered its former position, and at length
C 275 3
by degrees she was able to move the arm. She
had already acquired such use of the right leg, as
with the help of a stick to be able to walk about
the room. She now took Tinct. Rhois radicantis,
in increasing doses fi’om fifteen drops to half a
drachm in four ounces of an aromatic water. The
patient acquired, with respect to her natural state,
a blooming countenance, had a good appetite, and
gained both flesh and strength. Every thing went
on well; we thought of sending her, to complete
her cure, in June, to the baths of Toplitz ; yet the
pleasing prospect of a complete cure was soon to
be obscured.
From the beginning of the disease, though she
had before been regular, the menses had not made
their appearance. She now felt pains in the loins,
which extended forwards over the hypogastric re-
gion towards the pudendum, they returned periodi-
cally, and disappeared ; neither febrile state of the
pulse, nor any other derangement of the functions
of the body wei’e observed, and the whole was con-
sidered as propitious efforts of nature, which re-
quired no particular management, or at most, in
order to assist those efforts by applying cataplasms,
or taking occasionally Inf. Anthem., and afterwards,
Inf. Melissae. vel. Menthae cum Potass, tart, et Ext.
Anthem., and to encourage the circulation in the
lower parts by the use of the pediluvium.
In this state she continued some pax’t of the month
of June, without any change for the better ; on
the contrary, the pains became continual, and the
pulse febrile ; she lost her appetite, and the region
of the loins was painful on pressure, by pressing
with force on the abdomen, she experienced a
deep-seated pain near the lumbar vertebrae, the
bowels became costive, no menses appeared.
C 276 3
though a mucous discharge came from the vagina.
The presence of an obscure inflammation, which
might probably be in the mesentery, could not be
mistaken, and the treatment was directed accord-
ingly. She was put on strict diet, emollient cata-
plasms were applied to the abdomen, Dec. Alth.
mannat. and Mist. Amygd. pro potu,were ordered:
notwithstanding which, the inflammatory symp-
toms went on, the fever became more violent, the
pain in the region of the loins greater and more
extended over the abdomen. It was now that,
with a very unfavourable prognosis, leeches and
cupping-glasses were applied, emollient glysters
administered, and emulsions, with powders con-
taining calomel, were given. After a fortnight, in
which thirty-six leeches and forty cupping-glasses
were applied, | several sinapisms and friction with
Ungt. Ant. tart., as well as tepid baths were used :
the fever at length, about the middle of August,
terminated w'ith critical urine and sweat, and the
inflammation was perfectly resolved. With respect
to the paralysis, the patient had so far advanced
as to have recovered her voice and speech, could
move about with ease, and had acquired consider-
able power in the arm ; her appetite returned, a
cheerful state of mind and her blooming complexion
came back by degrees; our art had thus been
able to effect ”a considerable amendment, though
not a complete cure. She was at the close of the
season transferred to the general hospital, and on
the 8th of September, she was (at her desire to
visit her mother in the country,) discharged, being
enjoined an appropriate diet, and recommended
next spring to the Tbplitz waters, from the use of
which, in so young a person, and in one who had
already advanced so far towards it, a complete
recovery might be expected.
i; 277 2
This interesting case, which for eight months
was under treatment in the clinical hospital, affords,
though she was not entirely cured, a fresh proof
of what the persevering endeavours of our art are
able to effect, even in doubtful cases; and that
the protraction of a disease, however great, need
not discourage the physician in his exertions; but
it teaches also what very different modes of treat-
ment, according to the difference of circumstances,
may be indicated in the same patient. At the be-
ginning, the paralytic state required a moderately
stimulating practice ; afterwards, when the pow^ers
of life were almost entirely exhausted, the excit-
ing method was indicated in its full extent ; and
in the sixth month of her disease, on account of a
chronic inflammation of the intestines, it was ne-
cessary for several weeks to employ a strictly anti-
phlogistic treatment. No preconceived opinion,
attentive observation of nature at the patient’s
bed-side, can alone direct the physician to the
proper mode of treatment.
PLEURITIS SINISTRA ET ULCERA SYPHILITICA.
A bar-maid, eighteen years old, by her irregular
conduct betame syphilitic, for which she was
treated in the lock hospital of this place, during
two months. On the 12th of August, she was
seized with fever, and a darting pain in the left
side, which w'as considerably increased by taking
a deep breath, and by her frequent dry cough.
On the loth she came into the clinical hospital ;
her countenance was flushed, her eyes animated,
the tongue covered with a dirty yellow coat, the
taste bitter, no pain from extei’nal pressure on the
chest, but the pain on the left side continued, and
had even increased in violence; she could not lie
2 B
i: 278 ;]
upon it without exciting cough and increasing the
pain ; tlie alidomen was free from pain, the urine
turbid, having a copious lateritious sediment, the
heat of the skin considerably increased, the pulse
at about 100, was full and strong; the syphilitic
sores were healed, excepting an excoriation about
the size of a bean : six leeches and a poultice were
ordered to the part affected ; and inwardly, Dec.
Rad. Alth. cum Pot. nit. et Syr. Alth. The pain
was much relieved by the leeches ; so that on the
17th she could lie on the affected side, and had
passed a good night ; the prescription was not
altered, only with a reference to her previous
complaint half a grain of calomel was given twice
a day.
On the 18th, the pleuritic symptoms had in a
great degree disappeared, but the tongue was
still coated, and the taste bitter, which, with an
entire loss of appetite, indicated some gastric affec-
tion, which might now be treated with laxatives,
and Dec. R. Gram, cum Oxymel. simp, was given.
After using these remedies for some days, these
morbid appearances also gave way, the sores were
healed, and she left the hospital cured on the 24th
of August.
FEBRIS GASTRICA SABURRALIS.
A teacher of languages, sixty years old, of a
weakly habit of body, lost his appetite without
any assignable cause, had an inclination to vomit,
and in fact vomited a quantity of fluid clear as
water; whatever food he took seemed bitter: a
bitter tincture was of no service to him ; and after
passing five weeks in this sickly state, on the
13th of August, he sought for relief at the hospi-
tal : his countenance was pale and sunk, his ap-
C 279 2
petite quite gone, the tongue coated, his taste
clammy, the pulse frequent and soft, the other
functions natural : lie took Dec. Gram, cum Pot.
tart, which soon procured some loose evacuations:
this required a change for Dec. Tarax. cum Am-
mon. mur. and powders with divided doses of
ipecacuan. On the 16th the purging was much
less, the tongue remained foul : as there was still
no inclination for food, he took Inf. Rad. Ipecac,
(ex 3ss. parat.) ^vj. Ammon, mur. 3j. On the
18th there was not much change, but his stools
were now regular.
In this evidently debilitated state of the diges-
tive organs, the indication was to employ such re-
medies as might remove the atony of the intestinal
canal, without retaining any accumulated noxious
impurities ; for this he took the following, Aq.
commun. ^iv. Ext. Menyanth , Ammon, muriat. aa
5ss. ; and on the 20th, Aq. commun., Aq. cort. aur-
ant. aa ^ij. Ext. Card, benedict. 5j. The effect
of these remedies was so beneficial, that on the
22d the tongue became quite clean, and his appe-
tite returned; he perspired more than usual, the
urine threw down a mucous sediment, he advanced
rapidly towards a recovery, which w'as only inter-
rupted by a cough which he got by quitting his
bed when in a state of perspiration: the Decoct.
Polyg. amar. cum Ext. Glycyrrh. also removed the
symptoms, and on the 30th of August he returned
home cured.
HYDROTHORAX INFLAMMATORIUS.
A case of inflammatory dropsy of the chest, not
unlike one above described, occurred to a horse-
breaker, sixty-four years old ; a month before he
had had inflammation in the chest, which, partly
C 280 ;]
from inefficient treatment, partly from his own
neglect, had terminated in hydrothorax : he was
admitted on the 11th of August with general ana-
sarca, his respiration short, difficult, and distress-
ing, threatening suffocation, so that he gasped
for breath, and could not he down ; the urine was
very scanty : he had a blister ordered between the
shoulders, Dec. Alth. cum Infus. Fol. Digital, ex
9ss. parat, ; afterwards another blister to the ster-
num, and Dec. Alth. cum Liq. Potass, acetat. ex
Oxym. scill. and powders with Digitalis and Ca-
lomel. As the digitalis reduced the pulse to forty
strokes in the minute, and that intermitting, Dec.
Alth. cum Camphorae gr.ij. was given, but the
camphor was again omitted as the pulse became re-
gular. With the combined use of Dec. Alth. cum
Pot. acet. et Oxym. scill. with small doses of Plum-
mer’s powder, a continued abundant secretion of
urine took place, the anasarca vanished, every
complaint at the chest disappeared; the patient
could repose in any posture, and soon recovered
his health ; and at the close of the clinical school,
he was discharged cured.
THE END.
C. Smith, Printer, One Bell Yard, Strand.
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